PMC Staff Illness Line List

This information will be kept confidential by the employee health nurse (Jennifer Bryner) and the Infection Preventionist (Liz Bacom). If you have any COVID19 symptoms, please call the COVID Triage Hotline, between 8:30 am and 8:00 pm at 772-5788. If you feel this is an emergency, call 24/7.  In order to protect our co-workers, our patients and residents, PMC has implemented tighter restrictions for working when ill or when family members are ill.
For each day you are sick please contact your manager and submit a separate survey.  

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* 1. Are you personally ill or are you calling in because someone you live with is ill?

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* 2. Have you been told by public health or employee health to quarantine or isolate?

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* 3. Please provide your first name.

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* 4. Please provide your last name.

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* 5. Indicate your primary department

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* 6. What is your work status?  

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* 7. Date of absence?  You will submit a survey for each day you are absent/sick.

Date
Time

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* 8. Please check all symptoms that apply.  If symptom is not listed, please check other and add your additional symptoms.

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* 9. Did you receive a vaccination in the past three days?

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* 10. What is your Covid vaccine status?

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* 11. Have your notified your supervisor about your absence and if indicated, called the Covid Hotline at 772-5788?  

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* 12. Do you anticipate a COVID test today?  

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