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INFECTIONCONTROLSCREENING PLEASE PRINT LEGIBLY! Today's Date: Name: Date of Birth: Social Security #: TT R#: (Used for ID UMC Lab ONLY) Department: Supervisor: Clinical Designation (if applicable):
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How to fill out infection control screening:

01
Obtain the necessary form or questionnaire for the infection control screening.
02
Read the instructions carefully to understand the information required and how to provide accurate responses.
03
Begin by providing your personal details such as name, date of birth, contact information, and any other relevant identifying information.
04
Answer questions about your recent travel history, including any countries or regions visited within a specified time frame. Be honest and provide all requested details.
05
Disclose any symptoms you may have experienced or are currently experiencing, such as fever, cough, shortness of breath, sore throat, or body aches.
06
Indicate if you have been in contact with individuals who have tested positive for an infectious disease or if you have been in a high-risk environment.
07
Answer questions about your occupation or workplace, especially if you work in a healthcare or high-exposure setting.
08
Provide any additional information or disclosures that the form requests, such as recent medical procedures or underlying health conditions.
09
Review and double-check your responses to ensure accuracy and completeness.
10
Sign and date the form to verify that the information provided is true and accurate.

Who needs infection control screening:

01
Healthcare workers: doctors, nurses, technicians, and other healthcare personnel who have direct contact with patients are often required to undergo infection control screening to ensure they do not pose a risk of spreading infectious diseases.
02
Patients: In some cases, patients undergoing certain medical procedures or being admitted to healthcare facilities may need to undergo infection control screening to identify any potential risks or vulnerabilities.
03
Visitors: Depending on the policies of a facility, visitors or individuals entering certain high-exposure areas, such as intensive care units or specialized clinics, may be required to undergo infection control screening to minimize the risk of introducing or spreading infectious diseases.
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Infection control screening refers to the process of assessing and monitoring for potential infections in a certain population or setting.
Healthcare facilities, schools, and other organizations that handle large numbers of individuals are typically required to file infection control screening.
Infection control screening forms can usually be filled out online or on paper, depending on the requirements of the governing body.
The purpose of infection control screening is to prevent, detect, and control the spread of infectious diseases within a particular community or environment.
Information such as demographics, symptoms, travel history, and exposure risk may be required to be reported on infection control screening forms.
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