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Covid Questionaire

The Real Estate Board of New York (REBNY) has put together this Coronavirus (COVID-19) Health Screening Questionnaire Form (the “Form”)
which shall be distributed to all persons who are attending any in-person property showings and/or meetings with the undersigned real estate licensee (the “Broker”). This Form shall be distributed to all attendees within 24 hours of any scheduled meeting. Please understand that the purpose of this Form is to elicit information to help promote the health and safety of all persons who may be involved in the meeting and/or showing, and that taking precautionary measures to prevent the spread of the Coronavirus (COVID-19) is paramount to those efforts.
The Broker (or any agent of the Broker) may cancel or postpone any in-person showing or meeting without prejudice or penalty upon any
indication that a person who is attending the showing or meeting is exhibiting any symptoms of the Coronavirus (COVID-19) or any other cold
or flu-like symptoms. The person signing this Form hereby acknowledges and agrees that:
(i) the information requested on this Form is being provided voluntarily,
(ii)the information provided on this Form is confidential and is not intended for use outside of determining whether an in-person showing or meeting
can occur,
(iii) the refusal or failure to answer each question below may result in the cancellation of any scheduled meeting or showing, and that
the Broker reserves the absolute right, in their sole discretion, to refuse entry to that person;
(iv) if the answer to questions 1-3 is “Yes” that person
will not be permitted to attend the in-person showing or meeting;
(v) if the answer to question 4 is “Yes” and the answer to question 5 is “No” that
person will not be permitted to attend the in-person showing or meeting;
(vi) any person may be asked in the future to execute another Form in
connection with a future meeting and/or showing; and
(vii) they must notify the real estate licensee listed below if they become symptomatic and/ or test positive for COVID-19 within 48 hours of the last visit to the property. The Broker represents that they use and present this Form uniformly
and in the same manner for all in-person interactions and meetings and in accordance with all Federal, State and Local Fair Housing Laws.

 

    Have you knowingly been in close or proximate contact in the past 14 days with anyone who has tested positive for COVID-19 or who has had symptoms of COVID-19?

    Have you tested positive for COVID-19 in the past 14 days?

    Have you experienced any symptoms of COVID-19 in the
    past 14 days?

    In the last 14 days, have you traveled from or been in close or proximate contact with someone who has traveled from another state or country for which New York State requires a mandated self-quarantine period?

    If you answered “Yes” to question 4, have you completed the 14-day self-quarantine as currently required by New York State?

    Limitation of Liability Form for Coronavirus (COVID-19)

    With stay-at-home orders being lifted in New York State, any parties involved in a real estate transaction must
    continue to be aware of the risks that are associated with the Coronavirus (COVID-19).
    Throughout the course of a real estate transaction, it may become necessary for a party to enter or access a
    residential or commercial property in-person, which raises the possibility of potential liability resulting from
    exposure to the Coronavirus (COVID-19).
    By entering the property or permitting a party to enter the property, you acknowledge that there is an assumption
    of exposure to the Coronavirus (COVID-19) and any and all consequences that may result from such exposure,
    including but not limited to, physical injury, psychological injury, pain, suffering, illness, temporary or permanent
    disability, death or economic loss.
    This form is intended to notify the parties of the risks associated with conducting property visits in-person. All
    parties associated with the in-person meeting or showing (including the Agent or Broker) should sign this form. By
    signing this form, you hereby acknowledge and assume such risks and/or potential consequences.
    The undersigned hereby acknowledges receipt of this Coronavirus (COVID-19) Limitation of Liability Form and
    understands that the refusal to sign this form may result in the cancellation of any scheduled in-person meeting
    or showing.
    This form was presented to me by Jitender Thakur from Trig Realty CO


     

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