APPENDIX 12: Departmental COVID Control Plan Template

APPENDIX 12

Departmental COVID Control Plan Template

Below is the information required for the Departmental COVID Control Plan.

Click here to fill out this form online.

Vice presidents and deans are to coordinate efforts within their areas, assess their operations and submit this official request to bring employees back to campus.

Each request will be carefully scrutinized by the COVID-19 Task Force team leaders Gene Labonte, Assistant Vice President for Public Safety and Risk Management and Dr. Elisa Castillo, Assistant Dean of Students for Wellness. Consideration criteria include the operational needs, health and safety of the community, compliance with state guidelines, and will be reviewed in consideration of overall building and campus population density, among other factors.

Vice president’s or dean’s name

Vice president’s or dean’s email

Name(s) of the employee(s) seeking to return to work on campus:

Under normal circumstances, what is the total number of employees who would be working in this departmental space?

Out of the total (from the above question), how many people do your plan to bring back to campus at this time?

Building location of employee(s):

Room/office location of employee(s):

Schedule of the employee(s) [include days and hours]:

The operational need that requires the employee(s) to conduct the work on campus:

Explain why this work cannot be done remotely?

How will the mission essential functions of the department suffer if the work is not conducted on campus?