Visitor Screening – SUNY Poly COVID-19 Screener

Hidden

Date

In order to enhance the SUNY Polytechnic Institute Utica Campus efforts in minimizing community spread of the COVID-19 virus, and as required by the SUNY System Administration, contractors, consultants, vendors, and visitors are expected to complete a daily screening before entering the buildings of SUNY Poly’s Utica campus. Events may have an alternative screening process.

This Visitor Screening is necessary to help maintain a safe campus for all. Your cooperation is greatly appreciated.

SUNY Poly must be aware of the presence of individuals within its facilities, including: for whom they work; where they are working; with whom they are working; the purpose of their presence; and what they are doing.

Who Must Complete Visitor Screening

This Visitor Screening must be completed by all contractors, consultants, vendors, and visitors who will have a physical presence on the SUNY Poly Utica campus inside buildings or working on facilities / grounds with SUNY Poly community members (e.g., employees, students, tenants). This includes subcontractors, suppliers, service personnel, guest speakers, accommodation assistants, tour participants, etc.

This form should not be completed by residential or commuter students or employees, who should instead use the Daily Screening form before campus arrival.

Please also note, this procedure and form submission do not apply to personnel providing deliveries only (e.g. UPS, FEDEX, USPS), or service contractors providing routine services where activities occur on the exterior of the buildings, and interactions with on-campus personnel and students or others do not occur (e.g. waste removal, exterior pest control).

Visitor Screening Process

The sponsor / host must be an office or official at SUNY Poly and cannot be a student (except during student move in/out times – in such instances visitors should indicate the student name, campus email, and that the purpose is move in/out).

The visitor must contact the sponsor / host in advance of the visit to coordinate the visit and obtain contact information (e.g., sponsor / host email).

This screening must be completed the day of the scheduled visit before arrival on campus. The sponsor / host will be notified of the screening completion via an official, required “@sunypoly.edu” email. Upon arrival, the sponsor / host will verify the visitor’s current status with regard to the screening (any changes). All visitors will be required to sign in and out at the sponsor / host office (if open during the time of visit), or University Police Office (B126 Kunsela Hall). Check-in and meeting locations will be coordinated with the sponsor / host.

This process will be used to verify visitors’ presence on campus and ensure awareness of the COVID-19 restrictions. Contact tracing will also be possible using the information provided in this form.

Further, please be aware that unvaccinated individuals are expected to maintain a social distancing of at least six feet and wear appropriate face coverings to ensure source control and reduce the potential spread of COVID-19. All visitors are expected to wear masks indoors at all times, and when outdoors and unable to maintain social distance of at least 6-feet.

After Visiting

Please notify the sponsor / host if your health status changes following your visit (e.g., within 2 days of the visit COVID+ test result, COVID symptoms appear).

Our efforts to address the issues related to the pandemic are likely to evolve. Changes to policies may occur with little notice. Everyone’s cooperation is greatly appreciated as we work together to reduce the spread of COVID-19.

Section 1: Your Information

Are you a current SUNY Poly student (residential, commuter, online) or employee? *

No
Yes

Since you indicated that you are a current SUNY Poly student or employee, please use the appropriate screening form:

Your Name *

First Last

Email *

Phone Number *

Company *

Please enter the name of the company that you are representing. If your visit is not business-related, please enter “Self.”

Section 2: Information About Your Visit

Name of the Person You Are Meeting *

First Last

Email of the Person You Are Meeting

Office of the Person You Are Meeting *

Utica Campus Location/Building Being Visited *

Purpose of Visit *

Date(s) of Visit *

Expected Visit Start Time *

Section 3: COVID-19 Screening

Please answer the following questions:

In the last 10 days have you tested positive for COVID-19 or are you awaiting test results following a known COVID exposure or because you have recently had COVID-19 symptoms. Or if you have tested positive in the last 10 days, has it been at least 6 days since your positive test or symptoms started and you are allowed to follow the early release requirements (see link below) because you have no symptoms or your symptoms are improving, you have not had a fever in the past 24-hours, you do not have a runny nose or more than a minor non-producing cough, and you have a well-fitted mask that you can wear. You will also remain distant from others not in your immediate family or party. *

Early release requirements (pdf)

No
Yes

Are you experiencing or have you (in the last week) experienced any COVID-19 symptoms (see link to the symptoms list below) that cannot be attributed to other known pre-existing medical conditions, such as allergies or migraines, that have been diagnosed by a healthcare practitioner. *

List of COVID-19 symptoms

No
Yes

Have you knowingly been in close contact, in the last 5 days, with any person confirmed by diagnostic test, or suspected based on symptoms to have COVID-19? *

No
Yes

If “yes”, are you fully vaccinated and not eligible for booster vaccination or up-to-date (fully vaccinated and boosted) or have you been officially released from quarantine by the health department? *

No
Yes

Will your visit to campus involve being physically on the SUNY Poly Utica campus inside buildings or working on facilities / grounds “regularly”? *

The individual is “regularly” on campus (does not include single visits or visits that occur once a month) when they are present (a) at least weekly, or (b) for several days in one week, or (c) for extended times each day when on campus.

No
Yes

If yes, do you plan to “intermingle” with the campus community? *

The individual is considered to be “intermingling” with the campus community when they are (a) meeting in an office or other enclosed location with on-campus employees or students, or (b) being present in common areas using common facilities/equipment when others are present, or (c) being present inside dorm rooms or suites considered part of the student’s living area, or (d) performing a task where social distancing with SUNY Poly employees or students is not possible.

No
Yes

Visitors, Contractors, vendors, and service providers who are regularly on campus AND intermingle with the campus community (e.g., employees, students), must be vaccinated OR have a testing program in place. If you meet these criteria, please complete the Unaffiliated Entity COVID-19 Testing Program Certification form.

CAPTCHA