Go to Main Content
Ulster County Community College PROD
HELP
|
EXIT
COVID-19 Survey
To comply with NYS Standards all employees, students and visitors must complete the following questionnaire before entering campus each day.
* - Required
First Name
*
:
Last Name:
*
:
Date of Birth:
*
:
Phone Number
(XXX-XXX-XXXX format)
*
:
Have you experienced any of the following symptoms in the last 14 days?
*
Fever or chills
Cough
Shortness of breath or difficulty breathing
Fatigue
Muscle or body aches
Headache
New loss of taste or smell
Sore throat
Congestion or runny nose
Nausea or vomiting
Diarrhea
Yes
No
Have you tested positive for COVID-19 in the last 10 days?
*
Yes
No
Have you had close or proximate contact with confirmed or suspected COVID-19 case in the past 14 days?
*
Yes
No
Skip to top of page
© 2024 Ellucian Company L.P. and its affiliates.