COVID-19 Travel Advisory Quarantine Report Form

Instructions: To file a report of an individual failing to adhere to the quarantine pursuant to the NY State Travel Advisory, please submit the form below. Any information you provide is confidential. Items with a * are required fields. Thank you.

Additional Information on the NY State Travel Advisory

COVID-19 Travel Advisory Guidance
Executive Order

Traveler's First Name

Traveler's Last Name

Traveler's Street Address

Traveler's City, Town, Village

Traveler's ZIP Code

Traveler's Phone Number

Traveler's Date of Arrival in Erie County

State Traveling From

Your First Name

Your Last Name

Your Phone Number

Your E-mail Address

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