2:30 pm Motherhouse Tour & History of Sisters Dominican Sisters of Blauvelt | Sisters of Saint Dominic of Blauvelt, NY
Skip to Navigation Screening for Possible Novel Coronavirus COVID-19 Step 1 of 3 33% Please read before starting This form should not be completed by Dominican College students. If you are a Dominican College student, the correct screening form for you to use can be found here: https://dc.medicatconnect.com/ For others, this form can only be completed if you meet ONE OR MORE of the following criteria: (1) You or a member of your household has recently visited a CDC level 2 or 3 country (China, Iran, South Korea, Japan and several European countries (see them here)) (2) You or a member of your household has recently traveled to any other areas where the spread of coronavirus is a concern (3) You or a member of your household is exhibiting symptoms such as fever, cough, or shortness of breath (4) You or a member of your household has been exposed to anyone suspected or confirmed to have novel coronavirus. Do you meet ONE OR MORE of these criteria?* Yes No Thank you for participating in this survey. As you do not meet any of the criteria, no further information is required. You do not need to continue or submit the form. 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As you do not meet any of the criteria, no further information is required. You do not need to continue or submit the form. Instructions Please read each question and mark the box next to your answer (“Yes,” “No,” or “Unsure”). Please consider yourself, and members of your household, when answering. This is an effort to gauge the extent to which the College community may be exposed to the coronavirus. The Health Center will let you know if further steps are necessary before you can return to campus. Your answers will be shared with the Health Center, and other essential personnel. Over the last two weeks did you travel to China, South Korea, Iran, Japan, Hong Kong or any European country??* Yes No Unsure Where did you travel? Over the last two weeks did you travel to any other areas where the spread of coronavirus was a concern?* Yes No Unsure Where did you travel? Do you live in an area where the spread of coronavirus is a concern?* Yes No Unsure Where do you live?* Have you, or anyone in your household, been exposed to a suspected or confirmed case of coronavirus in the past 14 days?* Yes No Unsure Are you, or anyone in your household, exhibiting any signs of illness? (Select all that apply)* Fever Coughing Shortness of breath Other No symptoms What symptoms are you experiencing* Thank you for participating in this survey. As you do not meet any of the criteria, no further information is required. You do not need to continue or submit the form.NameThis field is for validation purposes and should be left unchanged.
