RMH Daily COVID Physician Tracker
REQUIRED to be filled out daily if on site at Ridge Meadows Hospital.
COVID-19 SCREENING QUESTIONS
COVID-19 SCREENING QUESTIONS
If YES to any symptom questions below, STOP and DO NOT START WORK
If YES to any symptom questions below, STOP and DO NOT START WORK
Go home and contact the UPCC for assessment and testing.
Date on Site at RMH
*
mm/dd/yyyy
Time
*
Please enter your time of arrival or departure from RMH
Department/Unit
*
Physician/Screener Name
*
College or MSP #
*
Do you have a FEVER or CHILLS?
*
YES
NO
Do you have a new/worsening COUGH?
*
YES
NO
Do you have new or worsening SHORTNESS OF BREATH
*
YES
NO
Do you have a SORE THROAT?
*
YES
NO
Do you have LOSS of sense of SMELL/APPETITE?
*
YES
NO
Do you have MUSCLE ACHES, HEADACHE or FATIGUE?
*
YES
NO
Do you have PAINFUL SWALLOWING?
*
YES
NO
Do you have NASAL CONGESTION?
*
YES
NO
Do you have new/worsening RUNNY NOSE?
*
YES
NO
REMINDERS:
REMINDERS:
Please remember to WASH YOUR HANDS PRIOR TO STARTING WORK and if you are not already wearing, please DON EYE PROTECTION AND MASK
If YES to any symptom questions above, STOP and DO NOT START WORK and CONTACT YOUR DEPARTMENT HEAD
If YES to any symptom questions above, STOP and DO NOT START WORK and CONTACT YOUR DEPARTMENT HEAD
Go home and contact the UPCC for assessment and testing. Please note that a copy of this data is shared with Site Medical Director.
*
Send me a copy of my responses
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