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Ulster County Community College PROD

 

HELP | EXIT

COVID-19 Survey

 

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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?*
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


In the past 10 days have you traveled internationally or to any State or territory other than Pennsylvania, New Jersey, Massachusetts and Connecticut for more than 24 hours?*

Yes No


(Optional) If you have travelled in the past 10 days internationally or to any State or territory other than Pennsylvania, New Jersey, Massachusetts and Connecticut for more than 24 hours, did you fulfill the requirements to "test out" of the mandatory quarantine period and been in contact with a college official regarding your test results? (Go to https://coronavirus.health.ny.gov/covid-19-travel-advisory for more information.)*

Yes No





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Release: NCCC 8.1