MMG Corporate Building or Clinic COVID Screening

* denotes required field

First and Last Name *

Employee Number *

• McLaren Employees: Use your employee number
• Providers: Use the last 4 digits of your phone number followed by a "P"
• Contractor / Vendor (without a McLaren HealthCare employee ID): Use "Contractor"
• Students [all students without McLaren employee ID]: Use “Student”

Your Email Address: (please use your @mclaren.org email address if possible). *

What is your organization? *

McLaren Bay Region

McLaren Bay Special Care

McLaren Caro Region

McLaren Central Michigan

McLaren Flint

McLaren Greater Lansing

McLaren Lapeer Region

McLaren Macomb

McLaren Northern Michigan

McLaren Oakland

McLaren Port Huron

McLaren St. Lukes

McLaren Thumb Region

McLaren Health Management Group

McLaren Corporate Building

Corporate Auburn Hills

CBS - Shelby

MMG Corporate Building

MMG

Contractor or Vendor

McLaren Integrated HMO Group

Manager Name. *

For Contractor / Vendor/ Student use McLaren assigned name.
1. In the Search Box, type your manager's last name then hit Enter.
2. SELECT your Manager by CLICKING THE BUTTON IN FRONT OF THE NAME
   (they will get a copy of the email)

Screening Questions

Question 1

Have you received the COVID-19 vaccine (Yes is fully vaccinated; No is either not vaccinated or only received 1 of 2 vaccine shot series)? For screening purposes only, not for reporting.*

No

Yes

Question 2

Have you been in close contact with a suspected or confirmed person with COVID-19? *
(within 6 feet for a total of 15 minutes or more in 24 hours to someone in your immediate household, or a community contact that your local health department notified you of )

No

Yes

Question 3

Do you have any of the following (New or unexplained symptoms)*:

• Cough, Fever (100.4 F or more)
• Shortness of breath
• Conjunctivitis (Red Eyes)
• New loss of smell or taste
• GI symptoms (diarrhea, vomiting, etc)
• Repeated shaking with chills
• Muscle pain
• Headache
• Sore Throat
• Congestion, runny nose
• Fatigue
• Myalgia (muscle pain)
• Arthralgia (joint pain)

No

Yes

Captcha*