ECRC Observation Online Registration Form
 Share
The version of the browser you are using is no longer supported. Please upgrade to a supported browser.Dismiss

 
$
%
123
 
 
 
 
 
 
 
 
 
ABCDEFGHIJKLMNOPQRSTUVWXYZAA
1
*The ECRC will be closed from March 16 through April 3*
2
*Please note, the ECRC is being intentionally conservative in reviewing visitors and only allowing essential personnel and UB visitors on-site. We are taking deliberate steps to monitor visitors in our center. Upon coming to the ECRC for observation, you will be asked to answer the following COVID-19 Screening Questions:
3
1. Have you experienced any of the following symptoms within the last 5 days?
• Fever (Temperature at/above 100.4 °F [38 °C])
• Cough
• Shortness of breath
4
2. In the last 14 days, have you been in close contact with anyone experiencing COVID-19 symptoms or who is confirmed to have COVID-19?

Close contact means (i) being within approximately 6 feet of a COVID-19 case for a prolonged period of time; close contact can occur while caring for, living with, visiting, or sharing a healthcare waiting area or room with a COVID-19 case or (ii) having direct contact with infectious secretions of a COVID-19 case (e.g., being coughed on).
5
3. Have you traveled to any of the following locations within the last 14 days?
• Mainland China
• Iran
• Italy
• South Korea
• Japan
• Any other location that has been confirmed to have widespread sustained transmission or sustained community transmission as established by the CDC or the WHO?
6
7
Please see the next tab for instructions to sign up for observation at the Early Childhood Research Center (ECRC).
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
Loading...