The QUESTIONNAIRE FOR WORK AT EXELON GENERATION NUCLEAR LOCATIONS is a mandatory step in Exelon's traveler screening process. The purpose of the form is to allow Exelon to review outages worked and/or travel conducted in advance of worker arrivals at Exelon facilities. This recent work and/or travel history will be reviewed against travel advisories which may be active. Please complete the form in the next 24 hours or your assignment start date may be impacted.

This form is the first of three screening actions that will be employed to keep sites safe and workers healthy. The other two screening actions are outage site testing for Covid19 and daily screening protocols.

Please complete all sections accurately and completely in order to allow for Exelon’s review/approval of your work and travel history. This form should take no longer than 5 mins to complete online and electronically submit back to Exelon. The form consists of the following sections: General Worker Information; Refueling Outages worked in the last 30 days; and Information on states subject to various travel restrictions

Questionnaire for Work at Exelon Generation Nuclear Plants

1. Provide a list of ALL refueling outages worked in the past thirty (30) days starting with date of in-processing and ending with the date that you left the outage and your mode of transportation.

NOTE: For “Mode of Transportation”, please list your method of arrival to the location (car, airplane, bus, train, etc) and if by car, whether you car-pooled or traveled alone.

If no outage work in the last 30 days, click remove

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2. Within the past 14 days, have you been a resident of or traveled to or from a city, county, or state (If you didn’t stop for any reason or you passed through the state and stopped only for a brief break of no longer than 30 minutes, please do not list):

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3. For each question in 2(a) through 2(c) for which you responded “yes” in an answer, provide the following information:

NOTES: In responding to “Reason for being there,” you may respond as follows: “Personal”, “Work”, or “Personal/Work.” If your answer includes Work and your work included for a nuclear power plant, list what nuclear plant in the “Reason for Being There” column.

For “Modes of Transportation,” please list how you arrived in the location, how you commuted while in the location, and how you left the location. List all modes of transportation (car, airplane, bus, train, etc.).