COVID -19

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COVID -19

Please answer each question to entry into our facility

Email *

Your Name *

Which Commonpoint Queens Location do you work in? *

1. Have you had any symptoms of COVID-19 (including 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), within the last 14 days? *

25 points

YES

Other:

2. Have you had a positive diagnostic COVID-19 test in the last 14 days? *

25 points

YES

Other:

3. Have you had contact with any persons with confirmed or suspected COVID - 19 within the last 14 days? *

25 points

YES

4. Have you been to a quarantined state as of June 25th? *

25 points

Yes

A copy of your responses will be emailed to the address you provided.

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