P.E.A. Seeks Information To Keep You Safe

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please take less than two minutes of your time to answer the questions below. This information will be collected and used to remedy all situations where problems exist.

Which worksite are you located? *

Rate the level of overall cleanliness in employee restroom facilities: *

What needs to be done in the employee restroom to improve the conditions?

Rate the level of overall cleanliness in your classroom or work-station: *

What needs to be done to improve the conditions of your classroom or workstation?

Are all student restrooms accurately stocked with paper towels?

Yes

I do not know

Clear selection

Are all student restrooms accurately stocked with hand soap?

Yes

I do not know

Clear selection

Are all staff restroom facilities accurately stocked with paper towels?

Yes

I do not utilize the staff restroom

Clear selection

Are all staff restroom(s) facilities accurately stocked with hand soap?

Yes

I do not use the staff restroom

Clear selection

If you answered above that you are missing hand soap and or paper towels, what is the position of the chief custodian?

Are you being denied the right to utilize personal hand sanitizer for personal use?

Yes

Clear selection

If yes, please provide more details.

Have you been provided with any "district-approved" disinfectant wipes?

Yes

Clear selection

If you have not received "district-approved" disinfectant wipes, please explain why.

Do you have an adequate supply of "district-approved" disinfectant wipes?

Yes

Clear selection

Have you had personal cleaning supplies confiscated by your head custodian or administrator within the last week (March 2-March 6)?

Yes

Clear selection

If yes, please provide us with the details?

Have you been provided guidance from the District on how to utilize the District's "approved" wipes?

Yes

Clear selection

Please add any additional comments:

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of patersonea.net. Report Abuse

Forms