COVID-19 Working Alone on Campus

This form is to be completed by the individual who will be working alone on any campus (lone worker) and must be completed each time an individual is working alone. Prior to completing the form, approval for working alone must be obtained from direct supervisor/manager.

Is your manager/supervisor your designated contact person?
I acknowledge that I will check-in with my manager/supervisor or designated contact person when I start working alone and when I finish working alone.