CWO Daily COVID-19 Screening
Email address *
Name *
Date: *
Have you been in close or proximate contact in the past 14 days with anyone who has tested positive for COVID-19 or who has had symptoms of COVID-19 *
Have you tested Positive for COVID-19 in the past 14 days *
Experienced any symptoms of COVID-19 in the past 14 days. *
Have you traveled anywhere on New York States Travel Advisory list in the last 14 days? *
If Yes to above question, have you quarantined for 14 days?
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If a Service Provider, have you taken your 2 week Covid test in the last 2 weeks?
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When was your last test?
If it was more than 2 weeks ago, please schedule your test asap.
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