New York State Mandatory Health Screening Questionnaire – COVID-19

Symptoms may appear 2-14 days after exposure to the virus. People with these symptoms may have COVID-19:

Have you had any of the following symptoms below in the past 14 days:
Please Contact Chuck Smith at 516-750-9373/csmith@wrightinsurance.com or Harriet Diamantidis at 516-944-2826/hdiamantidis@wrightinsurance.com or your Profit Center Leader Immediately
YesNo
Please Contact Chuck Smith at 516-750-9373/csmith@wrightinsurance.com or Harriet Diamantidis at 516-944-2826/hdiamantidis@wrightinsurance.com or your Profit Center Leader Immediately
YesNo
Please Contact Chuck Smith at 516-750-9373/csmith@wrightinsurance.com or Harriet Diamantidis at 516-944-2826/hdiamantidis@wrightinsurance.com or your Profit Center Leader Immediately
YesNo
Please Contact Chuck Smith at 516-750-9373/csmith@wrightinsurance.com or Harriet Diamantidis at 516-944-2826/hdiamantidis@wrightinsurance.com or your Profit Center Leader Immediately
YesNo
Please Contact Chuck Smith at 516-750-9373/csmith@wrightinsurance.com or Harriet Diamantidis at 516-944-2826/hdiamantidis@wrightinsurance.com or your Profit Center Leader Immediately
YesNo
Please Contact Chuck Smith at 516-750-9373/csmith@wrightinsurance.com or Harriet Diamantidis at 516-944-2826/hdiamantidis@wrightinsurance.com or your Profit Center Leader Immediately
YesNo
Please Contact Chuck Smith at 516-750-9373/csmith@wrightinsurance.com or Harriet Diamantidis at 516-944-2826/hdiamantidis@wrightinsurance.com or your Profit Center Leader Immediately
YesNo
Please Contact Chuck Smith at 516-750-9373/csmith@wrightinsurance.com or Harriet Diamantidis at 516-944-2826/hdiamantidis@wrightinsurance.com or your Profit Center Leader Immediately
YesNo
Please Contact Chuck Smith at 516-750-9373/csmith@wrightinsurance.com or Harriet Diamantidis at 516-944-2826/hdiamantidis@wrightinsurance.com or your Profit Center Leader Immediately
YesNo
Please Contact Chuck Smith at 516-750-9373/csmith@wrightinsurance.com or Harriet Diamantidis at 516-944-2826/hdiamantidis@wrightinsurance.com or your Profit Center Leader Immediately
YesNo
Please Contact Chuck Smith at 516-750-9373/csmith@wrightinsurance.com or Harriet Diamantidis at 516-944-2826/hdiamantidis@wrightinsurance.com or your Profit Center Leader Immediately
YesNo
Please Contact Chuck Smith at 516-750-9373/csmith@wrightinsurance.com or Harriet Diamantidis at 516-944-2826/hdiamantidis@wrightinsurance.com or your Profit Center Leader Immediately
YesNo
Please Contact Chuck Smith at 516-750-9373/csmith@wrightinsurance.com or Harriet Diamantidis at 516-944-2826/hdiamantidis@wrightinsurance.com or your Profit Center Leader Immediately
YesNo