Student Acknowledgement of Risk and COVID-19 Re-Entry Training

Name: Ulani Foran Date: 9/3/2020

Program/Course: MUS 100

Please check box to acknowledge that you have read/watched (video links) the following:

✔ To the best of my knowledge, neither I nor any member of or regular visitor to my household have, within the
last fourteen (14) days,
1) tested positive for or been exposed to someone who has tested positive for COVID-19, or
2) currently waiting for the results of a COVID-19 test, or
3) experienced any of the following symptoms: fever, cough, congestion, shortness of breath or difficulty
breathing, chills, repeated shaking with chills, new or unusual muscle pain, headache, sore throat,
nausea, diarrhea, new loss of taste or smell, or any sudden change in health; or
4) traveled outside the United States. If any of these conditions are present, I agree to contact and
receive instructions from the Office of Environmental Health and Safety by calling PCC Dispatch at
(520) 206-2710 BEFORE entering any College campus or office. If I experience any symptoms while at
the College, I will inform my instructor or Site Point of Contact and leave campus.

While the College understands that many of these symptoms can be due to a variety of conditions unrelated
to COVID-19, we are proceeding with an abundance of caution during this public health emergency.
✔ I understand that, prior to entering College facilities, I may be required to submit to an on-site body
temperature screening, and, if my temperature exceeds 100.4 degrees Fahrenheit, I will be directed to leave
the premises. While on campus, I will follow all health protection directives, including wearing a mask or
other protective equipment, maintain physical distancing, and hand washing.
✔ I understand that, if I have a chronic heart, lung, or liver condition, I may be at greater risk from COVID-19
exposure and should consult with my physician before returning to class in-person.

Please contact the College’s Access and Disability Resources Office (ADR) for information about disability-related
accommodations and adjustments. – ADRHelp@pima.edu

I affirm that, PRIOR to my arrival on campus, I have watched all the following videos in their entirety:

Requirement Duration (minutes)

✔ How to Slow Down the Spread of COVID-19 – (CDC) 1:12
✔ COVID-19 Stop the Spread of Germs – (CDC) 1:00
✔ How to Properly Wash Your Hands – Demo (CDC) 3:00
✔ How to Put on a Facemask and Disposable Gloves – PCC Video :50
✔ How to Remove a Facemask and Disposable Gloves – PCC Video :50
✔ Reentry Check-in – What to Expect during Check-in – PCC Video :12

✔ I also affirm that I understand and acknowledge that, notwithstanding my completion of the above-listed
training and adherence by myself and others, including college employees, to the prescribed guidance, my
participation in this program and/or presence at the College involves inherent safety risks, including possible
exposure to communicable diseases like COVID-19.

I certify that I have read, understand, and agree to comply with the provisions listed above.

Signature: Date: 9/3/2020

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