Calling in Sick

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?

I am not feeling well

Someone I live with is not feeling well

Neither apply

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

I am under quarantine due to contact to a positive case

I am awaiting testing or tested positive and isolating.

I traveled and am waiting for my second post travel Covid test.

Not applicable

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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

Activities

Acute Care

Administration

Business office

Clinic

Dietary

EVS

Facility

HIM

Home Health

Imaging

Laboratory

Long Term Care

Materials

Therapy

Screener at Airport or ER

Other (please specify)

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* 6. What is your work status?

Scheduled to work, did not report

Worked on PMC Campus, left work due to symptoms

Working from Home

Scheduled day off/PTO, reporting symptoms

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

Date and start time of your shift

Date

Time

AM/PM

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

I'm not sick but someone I live with is sick (check symptoms that apply)

Headache

Fever (greater than or equal to 99.5 degrees) or feel feverish

Chills

Cough

Shortness of Breath

Sore Throat

Head Congestion

Runny nose

Loss of taste or smell

Rash or other skin issues

Diarrhea

Nausea and/or vomiting

Abdominal Pain

Weakness, lack of energy

Muscle or joint pain

List other symptoms:

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

Yes, Flu shot

Yes, Covid Shot

Other vaccination

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* 10. What is your Covid vaccine status?

Not up to date

Up to date (All eligible Boosters received)

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* 11. Notifications, check all that apply:

I will or have notified my supervisor about my absence

I will call the Clinic at 907-772-4299 during regular hours for consultation and testing

My home Antigen is positive and I will notify Employee Health at 907-772-5704

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* 12. Did you take a COVID home antigen test today?

Yes, it is Positive

Previously positive, I am isolating.

Yes, it is Negative

Other (please specify)