Visiting NYSS Required Survey

Before making your way to the New York Studio School, we require that you complete this survey prior to each day that you plan to enter the building. Thank you for helping to bolster the health and safety of our community. Your responses will be used for admittance to the building and for any potential contact tracing only and for no other purposes.

Name*
First Last
Email*
Phone*
In the past 14 days, have you had any signs or symptoms of possible COVID-19, such as:*
Cough*
Shortness of breath or difficulty breathing*
Feeling feverish or a measured temperature => 100⁰ Fahrenheit
Chills
Muscle pain
Sore throat
New loss of taste or smell
Diarrhea
Headache*
*without known non-contagious or chronic cause
- Yes
- No
In the past 14 days, have you received a lab-confirmed COVID-19 positive result?*
- Yes
- No
In the past 14 days, have you had known close contact with a person who is lab-confirmed to have COVID-19?*
- Yes
- No
In the past 14 days, have you visited any of the following areas?*
Alabama
Alaska
Arizona
Arkansas
California
Delaware
District of Columbia
Florida
Georgia
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maryland
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Mexico
North Carolina
North Dakota
Ohio
Oklahoma
Puerto Rico
South Carolina
Tennessee
Texas
Utah
Virginia
Washington
Wisconsin
- Yes
- No
Consent*
I hereby certify that the information I am submitting is true, complete, and accurate to the best of my knowledge.
Email
This field is for validation purposes and should be left unchanged.

Visiting NYSS Required Survey

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