Patients and Visitors
Our Services
How You Can Help
Training and Research
News and Events
About Us
Patients and Visitors
Our Services
How You Can Help
Training and Research
News and Events
About Us
Submit
Contagious Illness Report Form for Lakeridge Health Colleagues
Name:
What site do you work at?
What site do you work at?
Ajax Pickering
Bowmanville
Oshawa
Port Perry
Whitby
Other, please Specify
Department:
Department worked in last:
Last day worked:
Contact Phone number:
Date of onset of symptoms:
Any family members/household contacts Ill with the same symptoms?
Yes
No
Please provide your symptoms.
Vomiting
Diarrhea
Nausea
Cough
Congestion
Fever
Malaise
Sore Throat
Additional Comments
Submit