St. John's COVID-19 Symptomatic Colleague Form

Symptomatic Colleague Testing Form

To prevent potential spread of COVID-19, colleagues are asked to self-monitor for possible COVID-19 symptoms. Colleagues who experience symptoms consistent with COVID-19 are required to contact their leader and fill in the form below to start the testing process.

If a colleague tests positive for COVID-19, the designated clinical team will provide further direction which may include, but not be limited to, contact tracing, symptom tracking, increased cleaning/ disinfecting and temporary worksite closures. 

Colleagues can report to the satellite lab located on the first floor by radiology during the following hours: M-F 7a-5p or Saturday 8a-11a. Testing will be completed in the main lab outside of satellite availability.

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Your manager will be notified via email. Please make sure you use the correct email address.
Today
COVID-19 symptoms defined by CDC: Fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea.
Are you fully vaccinated?:
Did you receive a 3rd shot or booster?:
Do you have direct patient contact?:
Are you pregnant?:
Have you tested positive in the past 90 days?: