NIAGARA UNIVERSITY GRADUATIONS          COVID-19 HEALTH QUESTIONNAIRE 5/20
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Email *
First Name *
Last Name *
Home Address *
Home City, State, Zip *
Home Phone Number *
Date of Birth *
Which Graduation Ceremony are you attending? *
Required
Has anyone in your household been within 6 feet of a person with a lab-confirmed case of COVID-19 for at least 5 minutes, or had direct contact with their mucus or saliva, in the past 10 days? *
Required
In the last 48 hours, has anyone in your household had any of the following NEW symptoms: Fever of 100.4 degree F or above, or possible fever symptoms like alternating chills and sweating, runny nose, sore throat, loss of smell or taste or a change in taste, nausea, vomiting, diarrhea, headache? *
Required
Have your or anyone in your household tested positive for COVID-19 or traveled internationally or from a state with widespread community transmission of COVID-19 per the New York State Advisory in the past 10 days? *
Required
I understand that if my temperature is at or higher than 100.4, or if I could not answer any of the above question, I am required to stay home and not attend or participate in the Niagara University Graduation.
A copy of your responses will be emailed to the address you provided.
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