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Ulster County Community College PROD



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

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Release: NCCC 8.2