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External/Escorted Visitor Request Form

A restrictive visitation policy affecting all external visitors is in place to maintain constructive operations during the COVID-19 pandemic crisis. External visitors include auditors, monitors, vendors, representatives, and others. The COVID-19 Incident Command Center will review all requests regarding access to UMMC-owned or leased property. External visitors will access areas only on a qualifying event. Complete the form below. The submitter will receive communications of the final decision.

* = Required Fields

The external visitor has previously completed the process for credentialing using the GHX Vendormate system.*
Is the external visitor going to


Is the external visitor providing training essential to patient care, mission completion, or hospital operations?
Name of the designated Point of Contact for this event or gathering.*
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UMMC employee phone number*() -    
* 
* 
* 
Phone number of external visitor*() -    
* 
* 
*  
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External visitor expects the environment to be (check all that apply)*




















 
The event requires (check all that apply)*


 
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The submitter verifies the provided information is complete and accurate.*
The submitter verifies the current UMMC COVID-19 Screening Protocol completion before allowing individuals into the event.*