Mac-Haydn Staff Materials Request Form 2021

COVID Test Submission

Use this form to submit your COVID-19 test results to the Mac-Haydn Theatre.
Please complete the following form. If you would prefer not to use this form to submit your health information, please notify Covid-19 Compliance Team that you will be bringing evidence of your result to them directly: testing@machaydntheatre.org
Name*

First NameLast Name
Email*
example@example.com
Date of Test*
Type Of Test*

PCRRapid AntigenBoth
PCR Test Result*

NegativePositive
Rapid Antigen Test Result*

NegativePositive
Please Upload Image(s) of Your Test Result(s)*

Browse Files
File types supported: pdf, jpg, jpeg, png, gif Cancelof
Are you experiencing any of the following symptoms?*

Fever, chills or a coughShortness of breath, difficulty breathing or fatigueHeadache, muscle or body achesNew loss of taste or smellSore throat or congestion or runny noseNausea, vomiting or diarrheaNone of the above
Over the last 5 days have you been in contact with anyone suspected of having or diagnosed with Covid-19?*

YesNo
Displaying COVID-19 Symptoms or Been Exposed?
We are very sorry to hear you are not feeling well or that you have been in contact with someone who has not been well.

As a precaution, we would prefer you contact our team before entering the Mac-Haydn Theatre Campus.

Next Steps
Submit this form immediately.

Then please email either your Supervisor or the Covid-19 Compliance Officer and Company Manger Julie Galorenzo immediately to let them know your circumstances.

Once they hear from you, they will connect to let you know next steps to take before you can return to work at the Mac-Haydn.

DO NOT ENTER THE THEATRE CAMPUS OR OTHER THEATRE HOUSING UNTIL YOU HAVE HEARD FROM OUR COVID-19 TEAM

Julie's Contact Information
Email: jgalorenzo@machaydntheatre.org
Phone: 973-420-3105
Are You Living In Cast Housing*

YesNo
People In Cast Housing
If you are using Mac-Haydn provided housing please contact a Mac-Haydn COVID-19 Compliance Officer immediately and, as a precaution, begin the process of self isolation in your own room.

If you have a roommate, please inform both the roommate and the Mac-Haydn COVID-19 Compliance Officer. Roommates of symptomatic staff members must also begin the process of self isolation.

The COVID-19 Compliance Team will contact you to discuss next steps.
No COVID-19 Symptoms?
Great to hear you are feeling healthy!

Once you submit this form you are good to enter the Mac-Haydn campus.
Should be Empty:

COVID Test Submission