Please note that when an employee completes this online form, it is not private but may be shared with infirmary personnel or other employees on a need-to-know basis. When an employee completes this form he or she acknowledges and agrees that College personnel beyond healthcare professionals will see the information.
Name
Cell phone
Home phone
When did you get sick?
List any pre-existing health concerns (i.e. diabetes, asthma, etc.)
Please check any and all symptoms that you have: Fever over 100 degrees Chills Cough Runny nose Sore throat Body aches Headache Fatigue Diarrhea Vomiting
If you have a fever over 100 degrees and any of the other symptoms listed above, please follow precautions to isolate yourself. Do not report to work. Make sure to drink plenty of fluids and rest. Return to work 24 hours after your fever has dissipated. Call the Infirmary at 724-847-6666 if you have any questions.