For the health and safety of everyone, all employees/visitors are expected to affirm that the information below is true and accurate on a daily basis.

Employee only: If you are not able to answer all questions below as “True”, you should not be at work and you should immediately return home and call your Supervisor and Talent Division at 602-764-1542 to discuss telework, leave or return to work protocols.

Visitors only: If you are not able to answer all questions below as “True”, you should reach out to your PXU contact.


1 I have NOT been diagnosed with COVID-19 by a healthcare provider since I last reported to work/school:
 
     

2 I have NOT been told to self-quarantine by a healthcare provider since I last reported to work/school:
 
     

3 I do NOT have one or more of the following symptoms that I cannot otherwise attribute to a non-COVID related, communicable disease or diagnosed health condition:
  • Fever of 100.4°F or higher
  • Chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Sore throat
  • Muscle or body aches (myalgia) that was not caused by a specific activity (such as physical exercise)
  • New loss of taste or smell
  • Headache
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea
 
     

3.A. If False is selected, have you been fully vaccinated (at least 2 weeks have passed since you received your second dose of a 2-dose series, or at least 2 weeks have passed since you received one dose of a single-dose vaccine):
  • If YES (fully vaccinated) and you have no symptoms of COVID-19, you may report to work.
  • If NO, but you have had COVID-19 within the previous 3 months AND are recovered AND remain without COVID-19 symptoms, you may report to work.

4 I have NOT come into close physical contact (within 6 feet and for a total period of time of 15 minutes or longer) with someone I know has tested positive for COVID-19 since I last reported to work/school:
 
     

5 I meet the established health screening requirements and I am cleared to work/attend school: