COVID Screener Questionnaire

OHO COVID-19 Screening Survey (OCSS) Screenshots

External Survey

First Screen with Privacy Statement and PRA Statement Collapsed:

pg. 1

OHO COVID-19 Screening Survey (OCSS) Screenshots

First Screen with Privacy Statement expanded:

pg. 2

OHO COVID-19 Screening Survey (OCSS) Screenshots

First Screen with the PRA Statement Expanded:

pg. 3

OHO COVID-19 Screening Survey (OCSS) Screenshots

First Screen with Errors:

pg. 4

OHO COVID-19 Screening Survey (OCSS) Screenshots

First Screen with date/time error:

pg. 5

OHO COVID-19 Screening Survey (OCSS) Screenshots

Second Screen – Survey Questions:

pg. 6

OHO COVID-19 Screening Survey (OCSS) Screenshots

Second Screen – Survey Question number 3:

Cleared for Hearing Screen:

pg. 7

OHO COVID-19 Screening Survey (OCSS) Screenshots

Cleared for Hearing Email:

pg. 8

OHO COVID-19 Screening Survey (OCSS) Screenshots

Check In Confirmation:

Not Cleared for Hearing Screen:

pg. 9

OHO COVID-19 Screening Survey (OCSS) Screenshots

OHO Case Manager Dashboard (Internal users):

pg. 10