Please only fill out this form if you are staying home from work because YOU feel unwell. Do not use this form to report symptoms of household contacts or absences unrelated to symptoms of infection.
Thank you for taking the time to report this anonymous data to the infection control department. We are sorry to hear you are not feeling well.
Please ensure that you communicate your absence to your supervisor.
Any questions about this form or the collected information can be directed to Aaron Malkowski (amalkowski@bmhvt.org) with Infection Prevention. Your supervisor may contact Infection Prevention to discuss your return-to-work timeline.
Feel better soon!