Hofstra University Visitors - Mandatory Health Screening Questionnaire
IMPORTANT: If you are a Hofstra STUDENT or EMPLOYEE – Do not complete this visitor form. Please complete the mandatory health screening for students/employees. Please access it via: https://my.hofstra.edu/web/home-community/mandatory-health-screening-questionnaire

Campus Visitors: In order to meet the workplace activity requirements as outlined in the Reopening New York standards, as well as following best practices for the safety and health of our community, the University is implementing this health screening for visitors coming onto Hofstra's campus.

IMPORTANT: If you answer YES to any of the three questions below, you are prohibited from entering Hofstra University's campus.

For questions about this screening questionnaire, please contact safestartHR@hofstra.edu.
Name *
Please enter your company/organization (if applicable).
Please enter the best phone number to reach you if we need to contact you *
Date of your appointment/visit. *
MM
/
DD
/
YYYY
Time of your appointment/visit.
Time
:
What is the name(s) of the person(s) you are visiting on campus, and their department/school? *
Please provide the building(s)/location(s) you are visiting.
Indicate if you have experienced ANY of the symptoms potentially related to COVID-19 within the past 14 days. Symptoms include: fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea. *
Have you tested positive for COVID-19 within the past 14 days? *
Have you knowingly had close or proximate contact with someone in the past 14 days who has tested positive for COVID-19 or who has had symptoms of COVID-19 (see above for list of symptoms)? *
Submit
Never submit passwords through Google Forms.
This form was created inside of Hofstra University. Report Abuse