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 day for the duration of the pandemic restrictions. Prior to completing the form, approval for being on campus and 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.