Admin On-Call - Shared Health

Please complete and submit the form below. Your entry will be added to the call log spreadsheet on the next regular working day.

Date of Call*

AOC Initials*

Type of Call*

Specimen Rejection
Clinical / Technical
Fire / Safety / Security
Human Resources
Inappropriate / Unnecessary / Unknown

Reason for Call*

Urgent (off hours)
In Hours
Not Urgent

Brief Description of Call*

To avoid security issues, do not use special characters in form field below (eg. !, ', #, $, %, ^, &, *, (, ), ?, etc.).

Action Taken / Required*

To avoid security issues, do not use special characters in form field below (eg. !, ', #, $, %, ^, &, *, (, ), ?, etc.).

Personal Health Information Act*

When submitting this information, I affirm that I will not disclose any personal or confidential information in accordance with the Personal Health Information Act. Additionally, I acknowledge that I am not authorized to share this account with anyone.

I agree
I disagree