Employee Wellness Monitoring

Essential. Exceptional. Erlanger
Your well-being is important to us! We value you! Thank you for being the light!
“Let gratitude be the pillow upon which you kneel to say your nightly prayer. And let faith be the bridge you build to overcome evil and welcome good”
Maya Angelou,
Happy Thoughts! Stay after it!

Instructions: Please complete this form ONLY if you are sick or have symptoms.

There is no daily action needed for employees who are well or do not have symptoms. After submission of this form, you will receive a telephone call at the number you provided in this form. If you do not answer after two attempts, Employee Health will email your supervisor.

Date Date * / MM / DD YYYY
Time Time * : HH MM AM/PM
Name Name * First Last
Job Title/Position: *
Employee ID or type in Physician, Fellow or Resident: *
Telephone number where you can be reached: Telephone number where you can be reached: * - ### - ### ####
Email *
Manager Name: Manager Name: * First Last
Your Manager's Email: *
Cost Center:
Department Name: *
Erlanger Campus *

Erlanger Campus Baroness East North Sequatchie Bledsoe EWC LIFE FORCE Physician Practices
Wellness questions:
Have you had a known exposure to COVID-19 in the past 5 days? *

Have you had a known exposure to COVID-19 in the past 5 days? No Known Exposure Family/Community Related Unknown Work Related
Do you have any of the following NEW symptoms? Cough, Shortness of breath, Sore throat, Loss of taste or smell, Headache or Diarrhea? *

Do you have any of the following NEW symptoms? Cough, Shortness of breath, Sore throat, Loss of taste or smell, Headache or Diarrhea? Yes, I HAVE NEW symptoms No, I DO NOT HAVE NEW symptoms
You will need to wear a mask the WHOLE TIME you are at the hospital and someone will contact you if you need additional testing.
Do you have any of the following NEW symptoms? Fever >37.8 C or 100.0 F without taking fever-reducing medication (i.e Tylenol, Ibuprofen, etc.)? *

Do you have any of the following NEW symptoms? Fever >37.8 C or 100.0 F without taking fever-reducing medication (i.e Tylenol, Ibuprofen, etc.)? Yes, I HAVE NEW symptoms No, I DO NOT HAVE NEW symptoms
You have selected that you DO HAVE NEW ONSET of symptoms and you will be contacted by Workforce/Employee Health at the number you provided above. Would you like to proceed?
*

You have selected that you DO HAVE NEW ONSET of symptoms and you will be contacted by Workforce/Employee Health at the number you provided above. Would you like to proceed?
No Yes
Have you been tested for COVID-19 in the past 10 days? *

Have you been tested for COVID-19 in the past 10 days? Yes No
What were the results of your COVID test? *

What were the results of your COVID test? Negative Positive Pending
Have you been vaccinated with the COVID-19 vaccine in the past 48 hours?
*

Have you been vaccinated with the COVID-19 vaccine in the past 48 hours?
Yes No
What are your symptoms? (Please select all that apply) *

What are your symptoms? (Please select all that apply) Cough Shortness of Breath Sore Throat Loss of Taste Loss of Smell Headache Diarrhea Fever >37.8 C or 100.0 F
Do you have a NEW loss of taste or smell, sore throat, or NEW cough or congestion?
*

Do you have a NEW loss of taste or smell, sore throat, or NEW cough or congestion?
Yes No
Nursing staff scheduled through the Staffing Management Center must also call this office at 423-778-7252. DO NOT COME TO WORK IF YOU HAVE A FEVER >37.8 C or 100.0 F.

•TN facilities: Weekdays during the hours of 8 AM–5 PM Employee Health will contact you directly for further evaluation. On holidays, weekends and after 5pm on weekdays, the House Supervisor will contact you directly for further evaluation.

•Erlanger Western Carolina Hospital: Call Employee Health at 828-837-6210.
If symptoms develop while at work, notify your supervisor immediately, and follow-up with Employee Health as described above. You must be cleared by Employee Health before returning to work.
By clicking the submit button below, you attest that the answers you have provided are true and complete and you understand that providing accurate information regarding your symptoms and exposures is critical to your safety as well as the safety of our patients and other employees.

Please, click submit ONLY ONE TIME. Thank you!

Employee Wellness Monitoring

Employee Wellness Monitoring

Wellness questions:

You will need to wear a mask the WHOLE TIME you are at the hospital and someone will contact you if you need additional testing.