• COVID Report Form

  • Form Instructions:
    • Fill out this electronic form for each employee (1 employee per form) with a positive COVID test result.
    • If you have questions about the form, please contact Wendy Priest at x333 or wpriest@mcr.health
    • This report form is for the employee only, not to report family or other household members that have tested positive for COVID.




  • First Date Employee Called Out
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY


  • *Reminder to enter PTO in Kronos for time missed work. If the employee has exhausted PTO, time missed will be unpaid.
    *Reminder – all employees must have a negative test result and must be cleared by Dr. Van Buren before they can return to work