Fillable RETURN TO CAMPUS REQUEST (California State University, Chico)

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RETURN TO CAMPUS REQUEST (California State University, Chico)

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(i) CALIFORNIA STATE UNIVERSITY , CHICO
Dept. Name:
RETURN TO CAMPUS FORM - PART 1
Instructions / Employee Review
Function/Services:
RETURN TO CAMPUS REQUEST
Departments should read the Return to Campus Guidelines and Expectations before completing the Return to Campus
Request. Campus repopulations will be tightly controlled and coordinated to mitigate potential risks and ensure the safety
of students, faculty, and staff, as well as the communities we serve. No unit or department shall return faculty, staff or
student employees to campus without appropriate authorization. Requests to return to campus will be evaluated
through a process of risk and resource assessment to establish approval, prioritization, and sequence. The Emergency
Operations Center (EOC) will be reviewing each department’s applicable risk assessment and prevention protocols before
employees or students are permitted to return to campus.
Following are the steps necessary to complete the Return to Campus Request: (Department shall not return employees
to campus until notified by EOC)
Step 1:
Department Director/Dean to complete Part 1 (Employees Requested to Return to Campus).
Submit to VP/Dean for review and approval.
Step 2:
For department/administrative/faculty offices:
Department Director/Dean to complete Part 2 (Departmental Risk Assessment).
Submit Part 2 and Part 1 to eoc@csuchico.edu.
....OR.....
For academic instructional/research space:
Chair/Faculty to complete Part 3 (Academic Instructional/Research Space Risk Assessment).
Submit Part 3 and Part 1 to eoc@csuchico.edu.
Step 3:
EOC will review documents (Parts 1&2 or Parts 1&3) and work with department to assign training and
ensure prevention protocols are complete and in place.
Environmental Health and Safety
1
06/18/2020
(i) CALIFORNIA STATE UNIVERSITY , CHICO
Dept. Name:
RETURN TO CAMPUS FORM - PART 1
Instructions / Employee Review
Function/Services:
PART 1 - Employees Requested to Return to Campus
Department to submit Part 1 for VP/Dean approval.
Instructions:
1) List all employees requested to return to campus in Summer and/or Fall on a full-time or partial-time basis and the estimated hours/
days requested to be on-campus.
2) Include information that explains the reason the employee(s) need to return to campus and why the services cannot be performed
remotely, or academic space must be used.
3) Employees 65 and older, as well as those with serious underlying medical conditions (as defined by the CDC), may be invited back to
campus to work. Employees who are unable to return to campus should contact the Benefits unit in the Human Resources Service
Center to explore available options by emailing leaves-workcomp@csuchico.edu or calling (530) 898-4360.
Summer 2020 Plan Fall 2020 Plan
Employee
Information
(to assign training)
Barg.
unit
Full time
on-campus
services
Partial
time
on-campus
services
Full time
on-campus
services
Partial
time
on-campus
services
Estimate days/hours per week
if known
Reason why services cannot be performed
remotely or academic space must be used
Use multiple lines if needed
Example – John Doe 07 X X Summer: Mon‐Wed – 8am to noon Need access to documents and files in office for
year‐end close
Example – Dr Jane Doe 03 X X Summer: Mon‐Th – 7am to noon Need access to chemicals and scientific equipment
Example – Student Asst n/a X X Summer: M/W – as needed Need to feed animals
For best results, save this form to your desktop before filling it out, and be sure to save changes.
Additional information may be attached if necessary.
2
Environmental Health and Safety
06/18/2020
(i) CALIFORNIA STATE UNIVERSITY , CHICO
3
Dept. Name:
Function/Services:
PART 1 - Employees Requested to Return to Campus
RETURN TO CAMPUS FORM - PART 1
Instructions / Employee Review
Summer 2020 Plan
Fall 2020 Plan
Employee
Information
(to assign training)
Attach list if needed
Barg.
unit
Full time
on-campus
services
Partial
time
on-campus
services
Full time
on-campus
services
Partial
time
on-campus
services
Estimate days/hours per
week if known
Reason why services cannot be
performed remotely or academic space
must be used
Use multiple lines if needed
Department Director/Dean: ____________________________________________________________ Proposed Start Date:
VP/Dean Approval: ___________________________________________________________________ Approval Date:
Environmental Health and Safety
06/18/2020
(i) CALIFORNIA STATE UNIVERSITY , CHICO
4
Dept. Name:
Function/Services:
RETURN TO CAMPUS FORM - PART 1
Instructions / Employee Review
PART 1 - Employees Requested to Return to Campus (cont.)
Summer 2020 Plan
Fall 2020 Plan
Employee
Information
(to assign training)
Attach list if needed
Barg.
unit
Full time
on-campus
services
Partial
time
on-campus
services
Full time
on-campus
services
Partial
time
on-campus
services
Estimate days/hours per
week if known
Reason why services cannot be
performed remotely or academic space
must be used
Use multiple lines if needed
Department Director/Dean: Department Director/Dean: ____________________________________________________________ Proposed Start Date:
VP/Dean Approval:VP/Dean Approval: ___________________________________________________________________ __ Approval Date:
Environmental Health and Safety
06/18/2020
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RETURN TO CAMPUS REQUEST (California State University, Chico)

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Completed 22 July 2020

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