Staff Illness/Exposure Reporting Tool (SIRT)

Use this form to report:


New High Risk COVID-19 exposure (at home, in the community, or at work)

New positive COVID-19 test result

If you are reporting symptoms, please take a Covid test before completing the form.

 
 

Please enter your OMC email address

 

List the best phone number to contact you (not work number)

 

If you have a alternate phone number for whatever reasons, please provide. Skip question if not applicable.

 

What is your manager/supervisor's first and last name?

 

Select your department

 

Which of the following are you reporting? (Select ALL that apply):


  • Exposure - you want to report a new potential COVID-19 exposure from a patient, co-worker, family member, friend, etc.
  • Symptoms - you have developed new symptoms consistent with COVID-19 (see symptom list below)
  • Home Positive Test - you would like to report a new home positive test you have taken that has not already been reported to OMC (e.g. home antigen test, or PCR done at another facility)