Daily Health Check – Accessible Form for Employees

This page provides UB employees with an accessible alternative to the text-based and web-based UB Daily Health Check reporting options.

All UB faculty, staff and volunteer faculty/staff who come to a UB or UBMD campus must omplete the Daily Health Check. If you are unable to use the text-based or web-based Daily Health Check, please complete the accessible form below every day you are on campus.

NOTE: All Visitors (e.g., invited guests, vendors) who are otherwise not affiliated with the university are required to complete the Daily Health Check prior to their arrival on campus. An accessible form for visitors is available here.

Please note that UB students, faculty and staff who are not required to complete the Daily Health Check are strongly encouraged to do so out of concern for their personal health and the health of the entire community.

For complete information on the required Daily Health Check, visit UB’s main COVID-19 page.

Source: Human Resources


  1. Enter all requested information on the form
  2. Click submit

Need Help Completing the Form?

Mark Coldren.

Mark Coldren

Associate Vice President

Human Resources

Townsend Hall

Phone: 716-645-8155

Email: mcoldren@buffalo.edu

Form Facts

Form Type: HTML Formstack

Requirements: Internet, Web browser

Updated: July 2020

Owner: Human Resources

If you have suggestions about improving the user experience of this form, please contact Human Resources via email (ub-hr@buffalo.edu) or phone (716-645-7777).