COVID-19 Safety Survey

Saw Mill River Audubon
275 Millwood Road
Chappaqua, New York 10514
914-666-6503

Office Hours
M/W/F 11:00 am to 4:00 pm
except major/school holidays
Email or call in advance.

All visitors to the SMRA office are requested to complete this survey before visiting the office.

If you answer “Yes” to any of the first three questions below, please do not visit the SMRA office.

If you do not have a current COVID vaccination, do not visit the SMRA office unless special arrangements have been made in advance. 

All visitors must wear a mask.

The survey results will be kept confidential and only accessed by the SMRA Executive Director and SMRA Office Manager.

COVID Safety Survey

  • MM slash DD slash YYYY
    If you have had a positive test result and had previous contact with other people in the SMRA office, please contact SMRA immediately.
  • We require a current COVID vaccination to visit our office except for special circumstances discussed in advance. If we don't already have your vaccination certificate on file you can upload it below. **OR YOU CAN SHOW US YOUR CERTIFICATE WHEN YOU VISIT **
  • ** ONLY REQUIRED ONCE Take a screen shot of your NYS Empire passport app on your phone that shows vaccination dates OR take a picture or scan of your vaccination record card. This information will be kept confidential.
    Accepted file types: jpg, jpeg, gif, png, pdf, heic, tif, Max. file size: 512 MB.