Below is questionnaire that all residents are required to complete before each use of our Fitness Center. Name* First Last Address*This field is hidden when viewing the formLocationAuto-Generated by URLThis field is hidden when viewing the formDateQuestionsHave you had direct/ close contact with any individuals diagnosed with COVID‐19 in the last (14) days?* Yes No Have you had a positive COVID‐19 test in the past (14) days?* Yes No Are you currently experiencing any COVID‐19 symptoms or have experienced symptoms within the last (14) days as outlined by the CDC?* Yes No Have you traveled outside the US specifically to any areas where a mandatory quarantine is in place when returning to NY?* Yes No NOTE: IF YOU ANSWERED YES TO THE QUESTIONS ABOVE, WE CANNOT ALLOW YOU TO USE OUR COMMUNITIES FITNESS CENTER. PLEASE STAY HOME, AND STAY SAFE.I affirm I will wipe down equipment before and after use, wear a face covering, and maintain a social distance of 6’ while using the fitness center* Yes Signature* Δ