1stUUPB Potential Contact Tracing Record
This form should be completed by persons needing to visit the campus or the designated event safety coordinator before coming to campus or at least within 24 hours after a 1stUUPB outdoor event being held. Please wear masks and maintain social distancing to protect our community.
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Date *
MM
/
DD
/
YYYY
Name of Safety Coordinator for Event/Person Visiting Campus *
Email Address of Safety Coordinator *
Group/Meeting Name/Reason for Campus Visit *
Please list names of all attendees; include phone number and email address for any people not listed in church directory (on Breeze). *
Indoor Areas of Campus Accessing/Accessed *
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