Employee Health Symptoms Survey

This survey is only for Valley employees with new symptoms.

NOTE: If you came here by accidentally clicking "I DO have these symptoms" on the daily COVID attestation pop-up but you do NOT actually have COVID symptoms then you may close this window without completing the survey.

After completing this survey, Employee Health will contact you same day if your survey is completed Monday through Friday, between 7:00am-4:00pm, and will respond to completed symptom surveys on the next business day if completed outside of those hours.

Please contact Employee Health directly if you are not contacted within that timeframe.

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* 1. Your Name (required)

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* 2. Your Personal Phone Number (required)
Please enter multiple phone numbers if necessary.  Your personal phone number is needed on this form in case the one stored in the HR system is not up-to-date.

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* 3. Your Valley Computer Username/Login (required)
This is what you enter to log in to computers at Valley Medical Center locations.  For most individuals this is a combination of letters from your first and last name.  For some  providers this could be a numeric value.  This is collected on the survey to validate your submission.

Please click the Next button to continue.

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