Emergency Transportation Request Form

 

 All Severe Weather Critical Staff should contact their supervisor for transportation assistance.

*=Required 

 

*First name: *Last name:
*County of Residence:      
*Title: *Unit:
 *Do you provide clinical care?  
    

 

*Contact phone number:
Please include the area code.
*E-mail Address: 
*Manager or Designee:
*Manager or Designee phone number:
*Manager or Designee e-mail address:
*Date/time scheduled to work: 
*Address:

Please include zip code. The command center will be using MapQuest to find your residence. 
Request Form Submitted By:    
(if other than name submitted)
 
To get a ride home, report to the Incident Command Center:
Cancer Center, 2nd floor (elevators closest to Ardmore Tower).

    

 

 

 

 

Quick Reference

Important Numbers

Main 336-716-2011
Patient Info 336-713-0000
Media 336-716-4587
Jobs 336-716-4717

Ways to Give
USNWR 2013-2014Magnet Hospital RecognitionConsumer Choice2014 Best DoctorsJoint Commission Report

Disclaimer: The information on this website is for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, evaluation or care from your physician or other qualified health care provider.