Daily Health Screen

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Daily Health Screen

Please complete the form below honestly as you enter the Next Level facility each day!
- Thank you!

NYS Travel Advisory Info
https://coronavirus.health.ny.gov/covid-19-travel-advisory

Last Name *

First Name (Please enter the same way each day) *

Select One *

Have you tested positive for COVID-19 or have you been in close contact with someone that has tested positive for COVID-19 in the past 14 days? Have you experienced any COVID-19 symptoms in the past 14 days? Have you visited a state that requires quarantine by NYS Guidelines (see description of form)? *

No To All

Yes to one or more (Please Do Not Enter The Facility Today)

Is your temperature OVER 100 degrees F upon entry? *

No (Clear to enter facility if "No To All" above)

Yes (Please Do Not Enter The Facility Today)

Submit

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