2022 COVID Health Self-Assessment for Participants & Attendees

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PLEASE FILL OUT BEFORE ARRIVING TO LOCATION: In compliance with NYC Parks and public event guidelines in NYC, all anticipated participants and attendees coming onsite to a Queensboro Dance Festival Inc. event or activity must complete the COVID safety assessment below before arriving to the event or activity location.

If you are feeling sick or have tested positive for COVID-19, please quarantine for 10 days and tune into our programming on Instagram!

MASKS are encouraged on site. Thank you for doing your part in keeping yourself and others as safe as possible so public events can be safely enjoyed by all.

Help Stop the Spread: Protect Yourself and Others
Wear a mask, sanitize/wash your hands often, cough and sneeze into your elbow, limit contact with surfaces.

First and Last Name (same as when you registered for event) *

What event location are you about to arrive to? (Name of place) *

You are: *

An event participant (performing or working staff)

An attendee (audience member)

Have you tested positive for COVID-19 in the past 14 days? *

Yes

Have you had close contact with a confirmed COVID-19 case in the past 14 days? *

Yes

Have you experienced any of the following symptoms in the past 48 hours:

Fever or chills
Cough
Shortness of breath or difficulty breathing
Fatigue
Muscle of body aches
Loss of taste or smell
Sore throat
Congestion of runny nose
Nausea or vomiting
Diarrhea

I testify that: *

I have experienced the symptoms above in the past 48 hours

I have NOT experienced the symptoms above in the past 48 hours

Have you been fully vaccinated at LEAST 2 weeks ago? *

Yes

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