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DANCER'S DEN NYC
Making Every Lesson Count
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Health Screening Form
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1. Have you experienced a fever of 100.4 degrees F or greater, a new cough, new lost of taste or smell or shortness of breath within the past 10 days?
NO
YES
2. In the past 10 days, have you been tested positive for COVID-19 using a test that tested saliva or used a nose or throat swab (not a blood test)? 10 days measured from the date you were tested, not the date you received the test result.)
NO
YES
3. To the best of your knowledge, in the past 14 days, have you been in close contact (within 6 feet for at least 10 minutes) with anyone while they had COVID-19?
NO
YES
Who was the first man to go into space?
NO
YES
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