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RD11141220State of New Jersey Department of the TreasuryDIVISION OF PENSIONS & BENEFITS RETIREMENT SECTION P.O. Box 295, Trenton, NJ 086250295COVID19 MEDICAL QUESTIONNAIREIn order to process your
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01
Start by reading the instructions provided with the questionnaire carefully.
02
Gather necessary documents such as identification and health records.
03
Answer personal information questions like name, age, and contact details.
04
Provide details about any current symptoms, if applicable.
05
Indicate any previous diagnosis or exposure to COVID-19.
06
Answer questions regarding travel history in the past 14 days.
07
Review your answers for accuracy and completeness.
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Submit the questionnaire as directed, whether online or in person.

Who needs covid-19 medical questionnaire?

01
Individuals experiencing COVID-19 symptoms.
02
People who have been in contact with confirmed cases of COVID-19.
03
Travelers returning from high-risk areas.
04
Participants in certain medical or research studies related to COVID-19.
05
Individuals required to complete the questionnaire for workplace or school entry.
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The COVID-19 medical questionnaire is a set of questions designed to assess an individual's health status in relation to COVID-19, including symptoms, exposure history, and vaccination status.
Individuals traveling to certain regions, employees reporting to workplaces, and others as mandated by health authorities or institutions may be required to file a COVID-19 medical questionnaire.
To fill out the COVID-19 medical questionnaire, individuals should answer all questions honestly, provide required personal and health information, and submit the form as specified by the requesting entity.
The purpose of the COVID-19 medical questionnaire is to prevent the spread of the virus by identifying individuals who may be symptomatic or at risk, thereby facilitating appropriate health interventions.
Information that must be reported typically includes the individual's contact details, symptoms experienced, recent travel history, potential exposure to COVID-19, and vaccination status.
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