NYC Agency Employee COVID-19 Screening Tool

  • 1 Current Your Information
  • 2 Screening
  • 3 Affirmation
  • 4 Complete

Reminder: please submit proof of vaccination to

You are being asked to answer this questionnaire in order to determine whether you have or may have COVID-19 or may have been recently exposed. This is being done solely for the purpose of protecting your workplace from potential spread of the disease. Any response you provide, and/or any directive you receive to stay home, does not constitute a diagnosis of COVID-19, nor are we advising you whether you need to get tested or contact a physician. You can consult CDC and health department websites for guidance in that regard.

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Math question is to prove that you are not a computer