Visitor Health Survey

Consistent with NYS guidelines, all visitors must complete a COVID-19 Questionnaire prior to your visit to campus. This questionnaire allows the College to act promptly should a visitor test positive for, have close exposure to or have symptoms of COVID-19. If you do not complete this questionnaire below, you will not be allowed to visit campus. To review the guidelines that are currently in place at the College, please visit https://www.strose.edu/restart/employees/.

Visitor Name

Phone Number

Email Address

Who are you visiting?

1. Are you currently experiencing, or recently experienced (in the last 48 hours), any new or worsening COVID-19 symptoms?? Yes No

2. Have you had close contact (being within six feet for at least 10 minutes over a 24-hour period) or proximate contact (as determined by health authorities) in the past 10 days with any person confirmed by diagnostic test, or suspected based on symptoms, to have COVID-19? Yes No

3. Have you tested positive through a diagnostic test for COVID-19 in the past 10 days? Yes No

I understand I will be required to wear a mask or a face covering inside College buildings, with the exception of residence hall rooms, residence hall bathrooms, offices that are occupied by one person, and while dining in accordance with the Centers for Disease Control and Prevention (CDC) and the New York State Governor’s Office.

Please review your responses before submitting. Should you indicate “yes” to any of the questions above, a member of College Administration will need to contact you prior to your arrival to discuss if your visit may continue as planned.