Weekly COVID Documentation Portal

The City of New York’s COVID Safety Requirement is in effect and City employees and contractors need to submit proof of vaccination or be required to submit a weekly diagnostic COVID-19 PCR test.

You are receiving this survey because your employer, Aya, has not received a copy of your COVID-19 vaccination status or because you have indicated that you are not vaccinated against COVID-19.

Testing
If you are unvaccinated, or do not wish to disclose your vaccination status, you will be required to submit a weekly diagnostic COVID-19 PCR test. All test results, positive or negative, must be submitted as part of this survey at minimum of every seven (7) days.

Noncompliance
Noncompliance with The City of New York’s COVID Safety Requirement will impact your ability to be scheduled for a shift, and possible removal from the Vaccine for All Corps.

Frequently Asked Questions (FAQs)
In the email you received with this survey link, there was an attached PDF with FAQs related to The City of New York’s COVID Safety Requirement, the survey, and other relevant items that will provide insights into this requirement and associated steps to comply.

Vaccinations
If you are vaccinated, you do not need to complete the survey. Proof of COVID-19 vaccinations, such as a vaccine card, must be sent to Aya. If you have misplaced your vaccine card, you have the option of obtaining a print record from your medical provider. Please refer to the FAQ for additional ways to obtain a replacement vaccine card.

You can also walk into many sites without an appointment; however if you would like to make an appointment, please go to https://vax4nyc.nyc.gov, call 1-877-VAX-4NYC, or visit nyc.gov/vaccinefinder1.

Any New Yorker requesting in-home vaccination can request their vaccine brand preference (Pfizer, Moderna, or Johnson & Johnson). Fill out the request form at nyc.gov/homevaccine or call 877-829-4692 to request an in-home vaccination.

Contact Information
Please contact Aya Healthcare at vax4allpayroll@ayahealthcare.com if you have questions related to the submission of proof of vaccination.

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* 1. Last Name

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* 2. First Name

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* 3. Date of Birth

Please select the date below.

Date

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* 4. Email Address

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* 5. Phone Number

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* 6. Which date did you take your test?

Please select the date below.

Date

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* 7. Is your test result positive or negative?

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* 8. Please upload a copy of your test result.

Please ensure the test result clearly shows your name, date of birth, date of test, lab/provider letterhead, PCR test result and sign-off/signature/license-number.

PDF, DOC, DOCX, PNG, JPG, JPEG file types only.

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By submitting any information including my COVID related health documents to SurveyMonkey, I authorize the New York City Department of Health and Mental Hygiene (DOHMH), including its employees, contractors, and agents to access, use, and disclose my information for compliance with the New York City COVID-Safe Requirement and applicable COVID-19 protocols.