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Tacoma General COVID response
*
1.
Please enter your contact information
(Required.)
Full Name
*
Unit
Shift
Personal Email Address
Cell Phone Number
2.
Have you been exposed to COVID at work?
Yes
No
If Yes, describe how.
3.
Have you been notified and COVID tested due to workplace exposure?
Yes
No
Comments?
4.
Were you notified within 24 hours?
Yes
No
If not, how long?
5.
Have you been notified by management for every COVID exposure?
Yes
No
Comments?
6.
If tested, how long did it take to receive your results?
8 hours or less
24
48 or more
Still have not received results
N/A
Comment?
7.
If COVID positive, were you encouraged, discouraged, or neither to file an L & I claim?
Encouraged
Discouraged
Neither
Who advised you to take action?
8.
Did you file an L&I claim?
Yes
No
9.
Were there any difficulties with filing that claim or obtaining time loss benefits or pay?
Yes
No
Comments?
10.
Have you been turned away from working when you called RMC to volunteer for a shift?
Yes
No
If yes please list date and unit.
11.
Have you been canceled by RMC when you volunteered to work an extra shift?
Yes
No
If yes please list date and unit.
12.
Have you personally been working a shift either flexed or without break relief when you know that someone volunteered to work and RMC turned them away?
Yes
No
If yes please list date and unit.
13.
Have you been at bed meeting where the House Supervisor has put a limit on how many RNs could be incentivized?
Yes
No
If yes please list date and unit.
14.
Have you ever had RMC or a House Sup or other manager tell you that they would not incentivize nurses to ensure break relief?
Yes
No
If yes please list date and unit.
15.
Has your facility restarted elective procedures and surgeries?
Yes
No
16.
Do you feel you have the staffing you need to support you in delivering safe patient care?
Yes
No
If No, please give details about how staffing has already negatively impacted safe patient care; include dates, times, specific examples.
17.
Do you feel that you have been paid correctly for all incentive shifts that you have volunteered to work?
Yes
No
If No, please give details about the shift in question; include dates, times, and the amount you believe you are owed.
18.
Have you experienced Low Census in the last 3 months?
Yes
No
If Yes, please provide date, shift, department, number of hours lost.
19.
Do you feel that you have the proper PPE to keep yourself and patients safe?
Yes
No
If no, please provide description.
