Step 1 of 5 - Registration 0% Welcome to the COVID19 risk assessment tool.*Please help us by answering a few questions about you and your health. You will receive advice on what actions to take based on national guidelines, and the data you enter will help us in predictive modelling and planning our national response to COVID-19. Thank you for coming forward and for contributing to the health of all citizens AND stopping the spread of the virus. I accept the terms (Read Terms and Policy) Name First Last How old are you?Under 1818-2425-3435-4445-5455-6465 or AbovePlease provide us with the gender you identify as*MaleFemaleSharing your location data will help us to further accurately map cases of COVID-19* Street Address Township/Area/Complex City Province Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Where are you going today?*Campus (Student/Staff)OfficePlease select a campus*eMalahleniAre you a:*StudentStaffVisitor Medical History*Do you have any other pre-existing medical conditions that we should be aware of?YesNoNot sure Do you feel very hot or cold? Are you sweating or shivering? When you touch your forehead, does it feel hot?*YesNoDo you have a cough that recently started?*YesNoDo you have a sore throat or pain when swallowing that recently started?*YesNoDo you have breathlessness or difficulty in breathing, that you’ve noticed recently?*YesNoHave you noticed any recent changes in your ability to taste or smell things?*YesNoHave you recently been in close contact to someone confirmed to be infected with COVID-19?*YesNoConfirmation*Please confirm that the information you shared is accurate to the best of your knowledge. Once you click the SUBMIT button, you will be unable to complete another HealthCheck for the next 24hours. Please note that the National Department of Health may contact you if necessary based on your responses.YesNo This iframe contains the logic required to handle Ajax powered Gravity Forms.