1. Have you experienced any of these symptoms in the past 10 days?
None of these symptoms
Fever or feeling feverish (e.g. chills, sweating)
Cough
Shortness of breath or difficulty breathing
New loss of taste or smell
2. Have you had a positive COVID-19 viral test result in the past 10 days?
Yes
No
3. Have you had interaction without a face covering with anyone with confirmed or suspected coronavirus within the last 14 days?
Yes
No
4. Have you traveled out of New York State in the past 14 days except to and from Canada?
Yes
No
5. Did you stay for more than 24 hours internationally, or in a state with wide community spread of COVID-19?
Yes
No
Which states have wide community spread of COVID-19?