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School or Facility You're Entering
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Fill Out Daily Screening
Have you experienced any symptoms of COVID-19, including a fever of 100.0 degrees F or greater, a new cough, new loss of taste or smell or shortness of breath within the past 10 days?
Yes, and I have received a negative result from a COVID-19 test since the onset of symptoms AND have not had symptoms for at least 24 hours.
Yes, and I am not in the category above.
In the past 10 days, have you gotten a positive result from a COVID-19 test that tested saliva or used a nose or throat swab?
(not a blood test)
To the best of your knowledge, in the past 14 days, have you been in close contact
(within 6 feet for at least 10 minutes)
with anyone who tested positive for COVID-19 or who has or had symptoms of COVID-19?
Have you traveled internationally or from a state with widespread community transmission of COVID-19 per the
New York State Travel Advisory
in the past 14 days?
This Health Screening is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a medical condition. Health screening results will be reviewed for the sole purpose of gaining access to facilities and confidentiality will be maintained.
Download a printable version of this questionnaire