OPS COVID-19 Employee Survey Form

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All staff must complete this form by 8:30 AM, prior to reporting to their respective locations. Note: The information collected from this form will be maintained as confidential and will be used to determine if you have potentially been exposed to or infected with the COVID-19 virus.

District Email Address *

Employee First Name *

Employee Last Name *

Position or Title *

Building Location (Please check all that apply) *

Orange High School

S.T.E.M. Innovation Academy of the Oranges

Orange High School Twilight Program

Orange Preparatory Academy

Central Elementary School

Cleveland Street School

Forest Street Community School

Heywood Avenue School

Lincoln Avenue School

Rosa Parks Community School

Oakwood Avenue Community School

Park Avenue School

Orange Early Childhood Center

John Robert Lewis Early Childhood Center

Scholars Academy

Blessed Hope

Montclair Child Development Center (MCDC)

Norjenes

Valley Settlement House

West Orange Community House

Central Office/Administration Building

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