Please check your temperature, if you do not have a thermometer report to 2nd floor Main Entrance or your designated area for screening. Do not complete FastPass.
PLEASE USE CAUTION AND DOUBLE CHECK YOUR ANSWERS.
Warning: Undefined variable $f in /home/pmchosp/public_html/demosite/wp-content/plugins/insert-php-code-snippet/shortcode-handler.php(237) : eval()'d code on line 15
Warning: file_get_contents(https://www.pikevillehospital.org/contents/audits/.html): Failed to open stream: HTTP request failed! HTTP/1.1 404 Not Found
in /home/pmchosp/public_html/demosite/wp-content/plugins/insert-php-code-snippet/shortcode-handler.php(237) : eval()'d code on line 16
| Alternate Email: | |
| Fill in the alternate email above If you want your fastpass email sent to an address other than the one on file, or if you have been instructed above to list an email. Emails may be delayed or be blocked by your provider. We STRONGLY suggest using your phone to fill out this form and make a screenshot of your confirmation page!!! | |
| Phone number where you can be immediately reached. | |
| Fever greater than 100.4 Fahrenheit? | Yes No |
| Shortness of breath or difficulty breathing? | Yes No |
| Cough? | Yes No |
| Chills, Muscle Pain or Body Aches? | Yes No |
| Sore Throat or Fatigue? | Yes No |
| New loss of Taste or Smell? | Yes No |
| Headache? | Yes No |
| Congestion or Runny Nose? | Yes No |
| Nausea, Vomiting, or Diarrhea? | Yes No |
You are considered a critical or essential worker. Centers for Disease Control and Prevention advises that you may be permitted to continue to work following exposure to COVID-19, as long as you are asymptomatic. Please refer to the link below on CDC’s Interim guidance for Critical Workers who may have had exposure to COVID-19.
Continue to self-monitor throughout the day, if you become ill at work, report symptoms to your supervisor and House Manager immediately.
By proceeding, you affirm that you have made absolutely sure you answered the questions accurately!
