Valley Medical Center

Employee Health Symptoms Survey

This survey is only for Valley employees with new symptoms or a COVID+ exposure.

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.

If you develop symptoms of COVID-19 and your symptoms require testing per the Fit for Duty guidelines (link), please seek rapid antigen testing and follow your department’s process for calling out sick as needed. A rapid antigen test is now the preferred method of testing for COVID-19. Since those results are available in 15 minutes or less, testing does not qualify for Paid Administrative Leave. Positive tests should still be reported to Employee Health; they will communicate with you about when you are cleared to return to work. Employee Health is open Monday through Friday, 8 AM to 4:30 PM, apart from VMC’s recognized holidays.

With a negative antigen test you can return to work if you meet the following criteria:

Fever free for 24 hours without the use of medicines
No uncontrolled cough
No uncontrolled nasal secretions
No active vomiting or diarrhea

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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.

Valley Medical Center

Employee Health Symptoms Survey

Question Title

* 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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* 4. Please indicate your COVID-19 vaccination status

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* 5. Please indicate if you've received a COVID-19 booster dose

Valley Medical Center

Employee Health Symptoms Survey

Question Title

* 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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* 4. Please indicate your COVID-19 vaccination status

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* 5. Please indicate if you've received a COVID-19 booster dose

* 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.