Important Notice

This online self-assessment has been replaced by the COVID-19 Touchless Self-Screening Stations.

If you are beginning your on-site work for your day or shift and have not yet self-screened at one of the locations, please do so immediately.

Touchless self-screening stations are now available for use 24/7 in the following buildings. All employees, students and volunteers must complete a self-screen before beginning your on-site work.

More information is available on the i2 self-assessment page.

Locations

Video Guide

COVID-19 Self-Assessment

Badge ID is not valid or associate account is inactive.

Enter your badge ID to get started

Your badge ID can be found on the back of your badge and you do not need the leading zeros.

It is also listed on your external i2 directory listing so that you can login and look it up or have another employee look it up for you if needed.

This form must be used for self-assessment by staff working at a Roswell Park facility. Remote workers do not need to complete the process.

Scan Card

Welcome {{user.fname}}!

{{user.title}} from {{user.department}}

For technical issues with this form please contact the Techdev Team

Feedback

Make sure to include any relevant details with your feedback.

Please select which of the following symptoms or risk factors you have had in the last 14 days?

Only select items that have NOT already been evaluated by Employee Health.

I had new onset of the following symptoms:
{{symptom}}

Within the last 14 days:
{{risk}}

Employee Health needs to talk with you!

Please enter the best phone number for us to reach you at and hit the save screening button. Your screening will not be counted unless this step is completed.

Phone number must be given.

Risk Factors Found

{{symptom}}
{{risk}}

Thank You!

Your positive screening has been recorded.

If you are an employee, volunteer, or contractor:

Do not begin working, don your mask and go directly to Employee Health (ASB 3rd Floor, 716-845-3219) during the hours of 7am-5pm Monday through Friday or the Assessment and Treatment Center, (ATC,Hospital 2nd Floor) all other times, including weekends and holidays.

If you are a student or vendor:

You have screened with symptom concerns. Do not begin your duties, don your mask, leave campus, contact your on-site supervisor, and see your primary care physician.

Additional Options

Thanks!

Your negative screening has been recorded.

You have screened without any concerns and are able to begin your work or your assignments.

Please monitor yourself throughout the day, and if you develop any symptoms go directly to Employee Health.

Additional Options

Create a calendar reminder

This is only designed and tested to work with Google Calendar, Microsoft Outlook and Apple Calendar.

Select the days of the week for reminders:
{{day}}

Select a time:

︿	︿	︿

﹀	﹀	﹀

Your Email We need this email to send you the calendar event.