CTB Covid-19 Questionnaires
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Name (First & Last): *
1. Have you experienced a fever of 99.6° degrees Fahrenheit or greater, a new cough, new loss of taste or smell, or shortness of breath within the past 10 days? *
2. In the past 10 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)? (10 days measured from the date you were tested, not the date you receivedthe test result.) *
3. 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 - 19? *
4. In the past 14 days, have you traveled internationally orreturned from a state identified by New York State as having wide spread community transmission of COVID-19 (other than just passing through the restricted state for less than 24 hours)? Visit https://coronavirus.health.ny.gov/covid-19-travel-advisory for applicable states. *
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