Tacoma General COVID response Question Title * 1. Please enter your contact information Full Name * Unit Shift Personal Email Address Cell Phone Number Question Title * 2. Have you been exposed to COVID at work? Yes No If Yes, describe how. Question Title * 3. Have you been notified and COVID tested due to workplace exposure? Yes No Comments? Question Title * 4. Were you notified within 24 hours? Yes No If not, how long? Question Title * 5. Have you been notified by management for every COVID exposure? Yes No Comments? Question Title * 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? Question Title * 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? Question Title * 8. Did you file an L&I claim? Yes No Question Title * 9. Were there any difficulties with filing that claim or obtaining time loss benefits or pay? Yes No Comments? Question Title * 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. Question Title * 11. Have you been canceled by RMC when you volunteered to work an extra shift? Yes No If yes please list date and unit. Question Title * 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. Question Title * 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. Question Title * 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. Question Title * 15. Has your facility restarted elective procedures and surgeries? Yes No Question Title * 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. Question Title * 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. Question Title * 18. Have you experienced Low Census in the last 3 months? Yes No If Yes, please provide date, shift, department, number of hours lost. Question Title * 19. Do you feel that you have the proper PPE to keep yourself and patients safe? Yes No If no, please provide description. Done
