COVID Questionnaire

Below is questionnaire that all residents are required to complete before each use of our Fitness Center.

Name*
First Last
Address*
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Location

Auto-Generated by URL
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Date
Questions
Have 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*

Questions