Sacred Space Astoria Health Questionnaire
For use during COVID-19 pandemic. Questions are within the current NYS guidelines dated 21Aug20.
Email address *
Have you experienced a fever of 100.4 degrees Fahrenheit or greater, a new cough, new loss of taste or smell, or shortness of breath within the past 10 days?
Clear selection
In the past 14 days, have you tested positive for COVID-19 using a test that tested saliva or used a nose or throat swab (not a blood test)? (14 days measured from the date you were tested, not the date you received the test result.)
Clear selection
To the best of your knowledge, in the past 14 days, have you been in close contact (within 6 feet for at least 10 minutes) with anyone while they had COVID?
Clear selection
In the past 14 days, have you traveled internationally or returned from a state identified by New York State as having widespread community transmission of COVID-19 (other than just passing through the restricted state for less than 24 hours)?Visit for applicable states
Clear selection
If you have answered yes to any of these questions, you will not be able to be on-site for work today. Please contact Kim directly at 734-377-5620 to notify her of your needs and if you have any questions. Thank you!
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