Coronavirus Safety Survey
This form is to be completed by any individual coming on to the premises for purposes of employment or visitation prior to their presence on campus. Remember, that this form only needs to be completed once weekly for employees. Employees should complete this form 24 hours prior to coming onto a campus to start the week. This tool is meant to alert campus supervisors to any potential issues and to facilitate a conversation between employee and their direct supervisor to determine whether or not the employee should report to a district facility.
Email address *
What is the next date you will be entering a district facility?
Select your supervisor
Clear selection
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