Covid Screening Form
Students, faculty and staff save time and
Anticipated Entry Point
250 Joralemon St
111 Livingston St
Name of Host
Name of Company
Email Address (will receive link to status valid for 4 hours.)
1. To your knowledge, have you been in close contact in the past 14 days with anyone who has tested positive for COVID-19 or had symptoms of COVID-19?
2. Have you tested positive for COVID-19 in the past 14 days?
3. Have you experienced any symptoms of COVID-19 in the past 14 days?
fever over 100 degrees
shortness of breath or difficulty breathing
chills and/or muscle ache
loss of taste or smell
blueish face or lips
4. Have you traveled outside the United States or to any state outside of New York State or those states contiguous to New York State (Pennsylvania, New Jersey, Connecticut, Massachusetts, or Vermont) in the past 10 days?
5. Please enter the date you most recently returned to New York State
6. If either scenario describes your actions since returning to New York, select Yes.
I was outside of NY State for more than 24 hours and I have “tested out” of the NY State mandatory 10-day quarantine by obtaining a test within 3 days of departure, prior to arrival in NY. I then quarantined in NY for 3 days and on day 4 took a COVID PCR test. I remained in quarantine until receiving the test result. Both tests were negative, and I have submitted the results of those tests to Brooklyn Law School.
I was outside of NY State for less than 24 hours and upon my entry into NY State I filled out the traveler form and took a COVID PCR test 4 days after arrival in NY.