Please fill in all of the required fields before you send the survey. Required fields have been marked with (*)
Survey must contain either PIN (Personal Identification Number - Croatian OIB) or personal document information
Select the address of your stay in Croatia. If the address can't be found please use the fields below this selections.
Please fill this fields if the address of your stay doesn't exist in the selections above.
If not in list please select 'Ostalo - inozemstvo'
Decrease by 0.5°C if the temperature was measured rectally / in the ear
If the answer is YES then fill in the table at the end of this survey with the information of people you have been in contact from two days before your first symptoms untill now.
Provide your contacts (household members and business associates) if you have been confirmed with Coronavirus infection.
Contacts are people you have spent more than 15 minutes in an enclosed space.
Please fill (in the note) the information such as year of birth, address, company name, type of employment and the date of the last day at work.
Describe the place of your work, how are you feeling and anything else you think that could be important to the epidemiologist