Calling in Sick

PMC Staff Illness Line List
Please complete this survey at the onset of your illness, even if you have not missed a day of work. This information is used to formulate a line list of employee illness to identify trends, track circulating illnesses, mitigate the spread of infection, and to assist with accurate mandatory reporting of staff illness. The goal is to identify potential outbreaks before they spread. This information will be kept confidential by Infection Control and Prevention (Employee Health).

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* 1. Please provide your first name

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* 2. Please Provide your last name

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* 3. Indicate your primary department

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* 4. What is your work status?

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* 5. Dates

Date
Date

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* 6. Please check all the symptoms that apply:

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* 7. Did you have any tests done (COVID home test, lab flue/RSV/COVID test, strep screen, GI panel, etc.)?
*Staff working in LTC must take a COVID test with any new respiratory "cold" symptoms: Fever/Chills, cough, sore throat, runny nose or nasal congestion, etc.
Contact Employee Health at 907-772-5704 for guidance.

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* 8. Notifications and Consults, check all that apply:

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