* = Required Information

By submitting the attestation below, I certify that I have read and understood the information provided at and have the ability to assess the as stated on a daily basis (until further notice). I will assess the clients I visit and that I will promptly notify HDA CARE at 718-422-4700 should I observe a patient that demonstrates respiratory infection symptoms or should the patient report respiratory infection symptoms. I further attest that I will not go to work prior to responding to the daily screening sent by HDA CARE. In addition, I further attest that I have watched the infection control and COVID-19 training.