Your Name _______________________________
Email Address ___________________________
Organization ______________________________
Phone Number __________________________
Title of Event _______________________________________________
Conference
Workshop
Day of
Week
Date(s) Time(s)
(start/end)
Number
of People
Setup Type
Building/Outdoor Space, Room(s) or
Equipment Needs
-
-
COVID-19 Event Approval Form
Other: _______________
PrograP
*Events with multiple locations of up to 50 people per location are all to be listed on this form. Please attach additional notes as needed. Please also note that
this form does not confirm space. Space must be arranged with the appropriate facility based on approval of the event.
Please describe the purpose and audience for your event:
Do you plan on having outside vendors present?
Yes
No
Will you have food at the event?
Yes
No
If yes, what type of food will you have? Prepackaged Delivered
Caterer
If delivered or catered, please indicate your
potential food provider: ________________________________
Please describe the food plans for your event:
This form is due a minimum of 2 weeks in advance of the proposed event and is intended for events with food, speakers,
vendors and/or events that are marketed to the campus community. Standard meetings of 10 people or less will not
require this form. Event capacity cannot exceed 50 attendees.
Today’s Date ___________
Off-Campus
Registered Student Organization (RSO)
(YHQW7\SH
Meeting
Department
Student
Faculty/Staff
Children
Other: _______________
Sponsor
Participants:
Yes
No
*Please note that this form does not confirm space. Space must be arranged with the appropriate facility based on approval of the event.
During this time, SIU Carbondale is exercising the utmost caution to ensure the health and well-being of our students,
faculty, staff and community members. Please answer the following questions as to how you will take precautions to ensure
the safety of event participants. Please reference the Restore Illinois Meeting and Social Event Guidelines for assistance by
visiting: https://dceocovid19resources.com/restore-illinois/restore-illinois-phase-4/meetings-and-social-events/.
Will you require face coverings? This is a mandatory requirement.
Will you ask event attendees if they are exhibiting COVID 19 symptoms?
Yes
No
Please visit the Restore Illinois Meeting and Event Guidelines Checklist for Wellness Screenings for questions to ask: https://
dceocovid19resources.com/assets/Restore-Illinois/checklists4/AllChecklists.pdf.
What other measures will you take to ensure proper cleaning and sanitizing procedures are in place?
Please
note considerations per working with the facility, vendors and/or caterers.
How will you ensure your event attendees adhere to social distancing guidelines in your event space(s)?
Please note considerations for event set-up, limiting congregation of people and movement of people during
the event.
Please provide any additional event details we need to know:
____________________________________________
Event Sponsor Signature/Date
____________________________________________
Dean/Director/Date
____________________________________________
Vice Chancellor or Provost Signature/Date
(Recommended to proceed)
____________________________________________
Chief of Police Signature/Date
(Recommended to proceed)
Yes
No
Will there be a videoconferencing or virtual option for high risk attendees?
By checking this box, event sponsor agrees to keep an accurate record of event attendees and will provide
this list, if needed, to appropriate campus personnel
Do you have appropriate PPE in place to hold the event?
Yes
PPE refers to personal protective equipment and includes masks, hand sanitizer and social distancing signage.
No
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