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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?
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Phone number of external visitor*() -    
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External visitor expects the environment to be (check all that apply)*




















 
The even 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.*