CCSC REQUEST TO WORK FROM HOME DUE TO COVID-19 QUARANTINE
I hereby affirm that my absence from work is due to an ordered quarantine associated with COVID-19, and I am currently capable* of completing my instructional duties from home. Further, I affirm I will provide a daily plan, interact with the class throughout the work day, respond to student and substitute questions, provide feedback, and be available virtually for any necessary meetings.
Entering your name below depicts your signature and your affirmation that all information provided is accurate.
Employee Name *
Employee School *
Today's Date *
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Number of days to Quarantine *
Start Date for Quarantine *
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Final Date of Quarantine *
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*If approved, and you experience symptoms that prohibit you from performing your essential duties, let your administrator know and you may begin using available leave.
Prepare answers for the following questions then discuss with your principal.
Technology: Please describe your internet and technology capacity to work from home and to connect with your classroom. Speedtest.net will provide you with a measurement for your internet speed (We are looking for 25 Mbs as a minimum). *
Availability: How will you be available during the work day to respond to students, substitute, and other staff during school hours? *
Instructional Engagement: How will you engage students in active learning through a variety of instructional methods and strategies. *
Substitute Assistance: What tasks will your substitute have to perform for you to complete your essential duties? *
Principal's Signature:
For office use only - leave question blank
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