1. 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 5 days?

1a. Have you recently tested negative following the development of these symptoms?

2. In the past 5 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)? (5 days measured from the date you were tested, not the date you received the test result.)

3. To the best of your knowledge, in the past 5 days, have you been in close contact (within 6 feet for at least 10 minutes) with anyone who has COVID-19 during their infectious period? (the infectious period starts 2 days before the person first had symptoms or before their test date).

3a. Have you received the COVID-19 vaccine (all required doses) and have 2 weeks passed since being fully-vaccinated against COVID-19?

3b. Have you fully recovered from COVID-19 within the past 3 months (3 months measured from the initial onset of symptoms or from the date of the laboratory confirmed test)?

4. Are you in compliance with Policy No. 66. Vaccine Mandate and Policy No 65. Employee Wellness Measures? (If you received a religious or medical accommodation, then please be sure to submit proof of your weekly PCR test. If you submitted proof that you received one dose of a two dose vaccine, the please be sure you submit proof of your second dose within 45 days after receiving the first dose.)

4. In the past 14 days, have you traveled for more than 24 hours to a state that is not contiguous to New York (see travel advisory for list), or to any CDC Level 2 or Level 3 Travel Health Notice country?

4b. If yes, have you met the quarantine criteria for travel?

Visit http://coronavirus.health.ny.gov/covid-19-travel-advisory for travel recommendations.