Daily Monitoring Form

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Daily Monitoring Form Survey Questions // Additional Information

Have you had close contact with a confirmed or suspected case of COVID-19 within the past 14 days?

Close Contact:

  • Living in the same house as someone who has a laboratory confirmed positive case
    of COVID-19
  • Caring for a sick person with a laboratory confirmed case of COVID-19
  • Being within six feet of someone with a laboratory confirmed case COVID-19 for roughly
    ten minutes or longer
  • Being in direct contact with someone’s secretions with a laboratory confirmed case of
    COVID-19 (coughed/sneezed on, kissed by, sharing eating utensils or cups)

Laboratory Confirmed Case:

  • An individual was experiencing COVID-19 type symptoms and was seen by a medical professional to obtain a COVID-19 test. This test is done by inserting a swab into both nostrils.
  • If you have been in contact with a laboratory confirmed case you would have most likely been contacted by public health officials through a network of contact tracers.       

Suspected case: 

  • Someone who is experiencing symptoms of COVID and has no other alternative diagnosis such as allergies, strep throat, arthritis, chronic cough due to smoking
  •  Someone is experiencing TWO of the following new and unexplained symptoms
    • Fever
    • Chills
    • Rigor
    • Excessive exhaustion
    • Headache
    • Sore throat
    • Loss of taste or smell
  • Someone who has the ONE of the following new and unexplained symptoms
    • Excessive cough
    • Feeling like you can’t catch your breath
    • difficulty breathing
    • Someone with severe respiratory illness (hospitalized/on a breathing machine) and has been diagnosed with pneumonia (lung infection) or acute respiratory distress syndrome (severe respiratory distress requiring a breathing machine)

Have you traveled out of the US / or any state that has a travel quarantine advisory?

New York State law does not require travelers to quarantine if the following criteria are met:

  • Time spent in a state with a travel advisory for less than 24 hours
  • Any stopping at rest stops in travel restrictive states during bus or car travel
  • Airport travel layovers
  • Passing through various stations during train travel
  • The state in question was added to the quarantine list after you arrived in New York State
  • The travel was at least 14 days ago

Have you had a positive COVID-19 test within the past 14 days?

  • You have been notified by a medical professional either in person or over the phone that your COVID-19 test has been positive.
  • You have been tested at either a COVID-19 state testing facility, primary care office, urgent care, local clinic and have been diagnosed with COVID-19.

Do you have a pending COVID-19 test?

You have been tested at either a COVID-19 state testing facility, primary care office, urgent care, local clinic due to either how you are feeling or you meet COVID-19 exposure criteria.

In the past 14 days, have you had any of the following COVID-19 symptoms?

These symptoms are all new and unexplained. If you have a lifelong medical condition that mimics various COVID symptoms (allergies, fibromyalgia, cough related to COPD), this is not a new or unexplained symptom.