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* 1. Name:

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* 2. Please indicate which floor you primarily work on.

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* 3. Please indicate your position or department.

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* 4. In the past 24 hours, have you experienced any of the following symptoms (please select all that apply):
*If symptoms present similar to COVID, a COVID swab will need to be obtained ASAP.*

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* 5. If you are experiencing symptoms, please indicate the approximate date and time when your symptoms first began. If you are not experiencing symptoms, please insert "NA".

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* 6. Have you been in close contact with anyone who has exhibited the above symptoms?

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* 7. To your knowledge, have you been in close contact with anyone who has tested positive for COVID-19 within the last 14 days?

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* 8. Have you seen a physician or completed any diagnostic testing (a rapid at home test, testing at clinic/pharmacy)? If so, please explain what testing/results you have completed or received.

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* 9. Have you ever tested positive for COVID-19. If so, please list the most recent positive date.

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* 10. What was the last shift you worked?

Date

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* 11. Please enter a phone number where you can be reached.

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* 12. Is the number provided able to receive and send texts?

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* 13. If applicable, please provide any additional details that have not been addressed above.

POSITIVE COVID-19 TEST
1.       Staff will need to quarantine at home and not report to work. Return to work would be based on meeting one of the following criteria:
a.       10 days have passed since symptoms appeared or since positive test, 24 hours have passed since last fever, and symptoms have improved
b.      7 days have passed since symptoms appeared or since positive test, 24 hours have passed since last fever, and symptoms have improved AND you have tested negative within 48 hours of returning to work.
*Staff with severe or critical illness or who are moderately to severely immunocompromised may have an extended quarantine than what is listed above*

2.       In times of a staffing shortage, healthcare facilities can utilize a contingency staffing capacity that could allow staff to return to work prior to 7 days. That criteria includes:
a.       At least 5 days have passed since symptoms first appeared or since positive test date (day 0), AND
b.      At least 24 hours have passed since last fever without the use of fever-reducing medications, AND
c.       Symptoms (e.g., cough, shortness of breath) have improved.
d.      Upon return to work, staff should continue to be masked and distance themselves from others when eating and drinking
*Healthcare facilities may choose to confirm resolution of infection with a negative PCR or a series of 2 negative antigen tests taken 48 hours apart*.
CONSIDERATIONS WHEN EXPERIENCING COVID-19 SYMPTOMS
1.       Anyone with even mild symptoms of COVID-19, regardless of vaccination status, should receive a viral test for COVID-19. The viral test could be an antigen test or a PCR test.
2.       One negative COVID-19 test suggests that the person is negative at the time of the test. For continued symptoms, people should consider continued testing until alternate diagnosis is confirmed or suspected
3.       A person should remain out of work if symptomatic and awaiting a result of a COVID-19 test.
4.       One negative PCR test is sufficient to return to work. If an antigen test is negative, best practice is to confirm with a PCR or with a second antigen test 48 hours later – however ultimately, clinical judgement and suspicion of COVID-19 infection can determine whether one can return or not to work.
5.       In general, COVID-19 testing should be performed by staff independently. Staff can reach out to the Infection Preventionist if they are having difficulty navigating or finding testing options.
CLOSE CONTACT/HIGH-RISK EXPOSURE TO COVID-19
·         Asymptomatic people with a high-risk exposure or close contacts whether they are staff or residents, should have a total of 3 viral tests:
1.       Day 1 (where day of exposure is day 0)
2.       If negative, 48 hours after first negative test (Day 3)
3.       If negative again, 48 hours after second negative test (Day 5)
*Post exposure testing takes place regardless of vaccination status and regardless of transmission levels.
·         In general, no restrictions from work is required for asymptomatic staff following an exposure.
·         In general, COVID-19 testing should be performed by staff independently. Staff can reach out to the Infection Preventionist if they are having difficulty navigating or finding testing options.

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