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covid-19 Form
Name
*
First Name
Last Name
Email
*
Phone
I am
*
Employee
Vendor
Client
Potential Client
Consultant
Visitor
Guest of Employee
Building Staff
In the past 10 days, have you tested positive for Covid-19?
*
Yes
No
Do you currently have any of the following symptoms: fever, shortness of breath, sore throat, or any other common Covid-19 symptoms?
*
Yes
No
In the past 14 days, have you traveled to any of the states or countries curently on the New York State's and US travel advisory and have you been advised by authorities to self-quarantine?
Yes
No
If you answered YES to either of the questions, do not enter common areas of the building, work in offices shared by more than 1 person, or handle food items. Please follow CDC's Covid-19 prevention and quarantine protocols.
All persons in the common areas of the building must comply with the social distancing and personal hygiene guidelines to help prevent the spread of Covid-19.
I acknowledge that I understand and will comply with the policy.
*
Acknowledgement
Thank you!
