Custodial Staff Screening Form

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Custodial Staff Screening Form

Any day you intend to be in school for any reason, please complete this form. If you answer Yes to any question, you may not be on campus, without first submitting a doctor's note to Human Resources, if your temperature is 100.0 degrees or over you are not permitted to work on campus.

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First Name

Your answer

Last Name

Your answer

Email Address

Your answer

Phone Number

Your answer

What campus will you be on today ?

Assunpink Center

Health Careers Center

Sypek Center

What Building will you be in?

ASP -A

ASP- Board Office

ASP-B

ASP-C

ASP- County Superintendent Office

ASP- Maintenance Shop

SYP-A

SYP-B

SYP-C

SYP-C Annex

HCC

What room(s) will you be in?

Your answer

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