Holland Patent CSD

Health Screening Daily Survey

The safety of the employees, students, families, clients, partners and visitors remains our top priority. As the COVID-19 outbreak continues, we will closely monitor the situation and will periodically update our guidance based on current recommendations from New York State.

Based on currently available information and clinical expertise, older adults and people of any age who have serious underlying medical conditions (e.g. serious heart disease, chronic lung disease or asthma, immunocompromised, severe liver disease, etc.) might be at higher risk for severe illness from COVID-19. If you are concerned about underlying medical conditions, please consult with your personal medical health care provider.

To prevent the spread of COVID-19 and reduce the potential risk of exposure to our workforce, we are conducting a simple screening. Your participation is important to help us take precautionary measures to protect you and everyone in this facility. We request you complete this screening everyday prior to entering a facility. Based on your response, you will be informed if you should report to work or if you can enter our facilities.

Screening Questions

Please select a valid role.

  1. Since your last day of work, or last visit here, have you had any of these symptoms?

    • Fever (temperature of greater than 100.0°F in the last 14 days)
    • Cough
    • Shortness of breath or difficulty breathing
    • Chills
    • Repeated shaking with chills
    • Muscle pain
    • Headache
    • Sore throat
    • Gastrointestinal Tract Symptoms (primarily affecting children only)
    • New loss of taste or smell

    Note: Answer “yes” if the symptoms you have experienced in the last 14 days are of greater intensity or frequency than what you normally experience.

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

  3. Have you had close contact with a confirmed or suspected case of COVID-19 within 14 days?

  4. Have you traveled internationally or from a state with widespread community transmission of COVID-19 per the New York State Travel Advisory in the past 14 days?

  5. When you took your temperature today was it greater than 100.0°F?

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