Return to Campus Work Request/Proposal

In-Person Instructional, Research and Instructional/Research Support

Name*
Employee Last Name Employee First Name
EMPL ID*
Email*
Employee Position/Title*
Department Name
Work Location*
Room #*
On-Site Start Date Requested*
MM slash DD slash YYYY
On-Site End Date Requested (if applicable)
MM slash DD slash YYYY
On-Site Days, Start/End Times:*
ex: Mondays 9-10am
Justification*
What responsibilities does this person need to complete on-site, why are these responsibilites unable to be performed remotely, how does this request fit the criteria outlined?
What workplace modifications will be implemented to support workplace safety?*
ex: Staggered shifts, space modifications, additional PPE, etc.
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