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Visitor Covid Survey

Format: 123-456-7890

COVID-19 Screening Questions

  1. Are you currently experiencing any of the following symptoms?
    • Fever (100.0 degrees Fahrenheit or greater)
    • Chills
    • Cough, Congestion, or Runny Nose (new or worsening)
    • Shortness of breath (new or worsening)
    • Muscle pain (new or worsening)
    • Headache (new or worsening)
    • Nausea, Vomiting, or Diarrhea (new or worsening)
    • Sore throat (new or worsening)
    • Loss of taste
    • Loss of smell
  2. Have you had any known close contact with a person confirmed or suspected to have COVID-19 in the past 14 days?
  3. Have you tested positive for COVID-19 through a diagnostic test in the past 14 days?
  4. Have you traveled outside the United States which would require quarantine as outlined in the NYS Travel Guidance?

Please review these questions and submit your response below. If you can answer Yes to any of these questions you must not come to the Geneseo campus.

Can you answer "Yes" to any of the COVID-19 screening questions list above on this form? *