Phoenix Counseling Center
Employee COVID-19 Screening

**The safety of PCC employees is our overriding priority. As the pandemic continues, we are monitoring the situation closely and following the guidance from the CDC and Oregon Health Authority. In order to reduce the risk of exposure to our staff, we are asking everyone to complete and submit this screening prior to coming to work in the buildings each day.**

Please complete each section by selecting the applicable YES or NO option.

1. Are you currently experiencing any covid symptoms? Fever above 100.4; cough; nasal congestion; shortness of breath/difficulty breathing; sore throat; new loss of taste or smell; chills; head/muscle aches; nausea/diarrhea/vomiting.
2. Have you tested positive in the past 10 days?
3. Have you been around someone who has tested positive in the past 10 days?
4. Have you traveled outside the state in the past 10-14 days?

Please provide your name and date below. 

Thank you!

Sent. Thank you!