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Request to Resume In-Person Operations Unit Contact Information (This question is mandatory) Unit Supervisor/Director Contact Information Supervisor/Director First Name Supervisor/Director Last Name Supervisor/Director Email Address Supervisor/Director UVM Phone Number (area code-xxx-xxxx) Supervisor/Director Cell or Home Phone Number (area code-xxx-xxxx) Person to contact to address any questions or issues if other than unit supervisor/director Other Contact First Name Other Contact Last Name Other Contact Email Address Other Contact UVM Phone Number (area code-xxx-xxxx) Other Contact Cell or Home Phone Number (area code-xxx-xxxx) Department or Activity Information (This question is mandatory) Name of Department or Activity: (This question is mandatory) Indicate main location of department or activity: Building Name Room Number Please list all additional locations (i.e. buildings and room numbers) for department or activity where applicable. (Note: Do not include individual employee office locations). For example, if your administrative offices are in Waterman, but you have department offices in Living and Learning B123, list "Living and Learning B123" in this box. Building Name and Room Number Building Name and Room Number Building Name and Room Number Building Name and Room Number Building Name and Room Number If other than 8:00-4:30, indicate hours of operation: (This question is mandatory) Preferred date range to resume in-person operation: Choose one of the following answers Please choose... Phase One: June 15 - June 30 Phase Two: July 1 - July 31 Phase Three: August 1 - August 31 Requested start date (subject to approval): Date format: dd.mm.yyyy Open date/time selector Format: dd.mm.yyyy 1900-01-01 2037-12-31 DD.MM.YYYY Upload employee list, using provided template. Additional files may be included below. Please upload at most one file Upload files × Upload file (This question is mandatory) Select appropriate school/college or unit/division from list: Choose one of the following answers Please choose... Athletics College of Agriculture and Life Sciences College of Arts and Sciences College of Education and Social Services College of Engineering and Mathematical Sciences College of Nursing and Health Sciences Continuing and Distance Education Diversity Equity and Inclusion Division of Finance and Facilities Enterprise Technology Services Enrollment Management Graduate College Grossman School of Business Honors College Larner College of Medicine Operations and Public Safety President's Office Provost's Office Research Rubenstein School for Environment and Natural Resources Student Affairs University Communications University Libraries Checklist for Resumption of UVM In-Person Operations To assist and guide in the preparation of the department or activity’s plan, please be sure the plan addresses the following: (This question is mandatory) 1. Monitor Personnel Yes No Not Applicable 1a. There is a process for verifying daily that each employee is free of COVID-19 symptoms Yes No Not Applicable 1b. There is a supervisor identified to be available who will review the employee reported symptoms and enforce stay-at-home requirements for persons with symptoms and persons at increased COVID-19 Risk Yes No Not Applicable 1c. If you hire an outside contractor or vendor to be on-site, they have signed the necessary agreement through UVM Purchasing Services and agreed to comply with all provisions. Yes No Not Applicable (This question is mandatory) 2. Cleaning and Hygiene Procedures Yes No Not Applicable 2a. Handwashing facilities or appropriate hand sanitizers are available. Yes No Not Applicable 2b. Areas have been identified that personnel will regularly clean including the frequency. Yes No Not Applicable 2c. The plan includes requirements for face coverings and includes a communication plan about the requirement. Yes No Not Applicable (This question is mandatory) 3. Reduce Potential for Transmitting COVID-19 Yes No Not Applicable 3a. Appropriate personnel been identified that can continue to work remotely. Yes No Not Applicable 3b. Workspaces have adequate room for people to maintain 6’ spacing. Yes No Not Applicable 3c. Schedules have been adjusted to reduce number of concurrent personnel in a space. Yes No Not Applicable 3d. There are controls in place that provide adequate protection for personnel (signange, plexiglass barriers, etc.) Yes No Not Applicable 3e. Job tasks have been assessed and assigned appropriate personal protective equipment. Yes No Not Applicable 3f. Common touchpoints have been eliminated, or reduced and a cleaning/disinfection procedure developed. Yes No Not Applicable 3g. There are adequate procedures for cleaning and disinfecting shared workspaces and equipment, such as breakrooms, kitchenettes, printers, copiers, reception spaces, and othe spaces and equipment. Yes No Not Applicable 3h. There are adequate procedures to ensure regular cleaning and disinfecting of, and minimize congregating in, break areas, lunch areas, and other common areas. Yes No Not Applicable (This question is mandatory) 4. Inform Personnel and Enforce Procedures Yes No Not Applicable 4a. All personnel have completed the UVM COVID-19 Protecting Community Health & Safety training. Yes No Not Applicable 4b. There is a process to inform all personnel of the specifics of the plan and requirements including any necessary training. Yes No Not Applicable 4c. If PPE is required, appropriate training is included and there is a means of documenting completion of training. Yes No Not Applicable 4d. There is a process to inform all personnel of reporting requirements if they become at increased COVID-19 Risk. Yes No Not Applicable Resumption of In-Person Operations Plan Submit completed UVM Resumption of In-Person Operations Plan, along with any additional files, for review by the UVM Health, Safety and Resumption of In-Person Operations Committee. Please upload at most 5 files Upload files × Upload files Submit Load unfinished survey Resume later Please confirm you want to clear your response? Exit and clear survey ×
