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TA736 COVID-19 (04/21)New York State Division of Tax AppealsCOVID19 Health Screening Report Hearings This form is to be completed by any individual, other than a Division of Tax Appeals (DTA) employee,
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Obtain the covid-19 health screening report form from the relevant authority or organization.
02
Fill out personal information including name, contact details, and any identification numbers required.
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Answer all the questions on the form accurately and honestly regarding any symptoms, recent travel history, and close contact with confirmed cases.
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Submit the completed form as per the instructions provided.

Who needs covid-19 health screening report?

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Individuals who are required to do so by their workplace, school, or any other organization as part of their COVID-19 safety protocols.
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Individuals who are experiencing symptoms or have been in close contact with confirmed cases and need to provide information for contact tracing purposes.
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The COVID-19 health screening report is a document used to track and monitor individuals' health status in relation to COVID-19.
Employers, schools, and public health agencies may be required to file COVID-19 health screening reports.
The COVID-19 health screening report can be filled out either electronically or on paper, and typically requires individuals to provide information about their symptoms, test results, and potential exposure to the virus.
The purpose of the COVID-19 health screening report is to help track and contain the spread of the virus by identifying individuals who may have been exposed or infected.
Information such as symptoms, test results, and potential exposure to COVID-19 must be reported on the COVID-19 health screening report.
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