NorthShore COVID-19
Employee Screening Questionnaire

NCH team members continue to complete this questionnaire within 2 hours prior to entry of any NCH facility.

NorthShore and Swedish team members are no longer required to complete this questionnaire as of 9/14/21. Instead follow Self-Screening guidelines.

View Self-Screening Guidelines

Inform Employee Health Services of COVID-19 related symptoms and status changes

Important Notice: NorthShore now requires all team members to be fully COVID-19 vaccinated by October 31. See Pulse or your supervisor for details.

Vaccinated outside of NorthShore? Submit your record asap.

Schedule or walk into a clinic near you to get vaccinated today.

City of Chicago Travel Advisory.
For more updated travel information please click here.

Thank you for all you are doing to support NorthShore, our patients and one another.

Only NCH team members are required to complete survey.
NCH Employee ID
(or enter "000000" if you do not have a NCH Employee ID)
* must provide value
Last Name
* must provide value
Have you...
  • Had any new symptoms of COVID-19 (Fever, chills, cough, shortness of breath, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion, runny nose, nausea, vomiting, diarrhea),
  • Traveled to a high risk state*/internationally in the last 14 days, unless your primary residence is in that state.
    *Alabama, Alaska, Arizona, Arkansas, California, Colorado, Delaware, Florida, Georgia, Hawaii, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, Guam, Puerto Rico, and the Virgin Islands.
  • Had an exposure to a CONFIRMED positive Covid-19 person within the last 14 days?
    • Exposure = Within 6 feet for longer than 15 mins AND not wearing appropriate PPE.
    • Appropriate PPE = MASK in community/home/coworker OR MASK and EYE PROTECTION for patient care.

View High Risk States
* must provide value