Employee Check In

Faculty/Staff Campus Access Form

This attestation was developed with guidance from the Spokane Regional Health District.
First Name:
Last Name:
CTCLink ID:
Email:
Phone:
No identifying data found. If you encounter an error while completing your attestation, please notify Customer Services at ITSupportCenter@ccs.spokane.edu or (509) 533-4357 so it can be resolved and notify your supervisor of your health attestation status.

all fields required

Check In:

Head Start employees: if you work on the SCC or SFCC campus, please select that campus. All other locations please select District.

Select the campus you are visiting:

Supervisor:

Health Status Screening

Before you go to campus/work, please document your health status.

PLEASE NOTIFY YOUR SUPERVISOR IF YOU HAVE BEEN DIAGNOSED WITH COVID-19.

IF YOU HAVE ANY SYMPTOMS OF COVID-19, PLEASE CONTACT A MEDICAL PROFESSIONAL. EMPLOYEES SHOULD NOTIFY THEIR SUPERVISOR IF THEY ARE NOT ATTENDING WORK DUE TO COVID-19 SYMPTOMS.

Faculty/Staff Health Survey

Before leaving your home to go to Community Colleges of Spokane (CCS), Spokane Community College (SCC), or Spokane Falls Community College (SFCC), review the symptom list below and answer the following questions.

Fever
Chills
Cough
Shortness of breath or difficulty breathing
Fatigue
Muscle or body aches
Headache
New loss of taste or smell
Sore throat
Congestion
Nausea or vomiting
Diarrhea

Have you experienced any of the symptoms listed above in the past 14 days that you cannot attribute to another condition?

Yes
No

Within the past 14 days, have you had close contact with anyone that you know has been diagnosed with COVID-19? Close contact is defined as 15 cumulative minutes of exposure at a distance of 6 feet or less with a person.

Yes
No

Have you had close contact with someone who has any of the symptoms listed above AND is awaiting a COVID-19 test result OR have you been told by a public health or medical professional to self-monitor, self-isolate, or self-quarantine because of concerns about COVID-19 infection?

Yes
No

Have you had a positive-COVID test for active virus in the past 10 days?

Yes
No

If you plan on visiting somewhere besides your office or classroom when you are on campus and will be in close contact with other people, which means closer than six feet away for more than 15 minutes, please enter that information below.

If you answered "YES" to any of the questions above,
- Please notify your supervisor you will not be coming to work and why.
- You are encouraged to be tested for COVID-19.
- If you do not have a doctor or healthcare provider, free or low-cost testing is available at several locations in Spokane to anyone. If you live in a different county please click here for testing locations.
- You may return to work once you have completed a quarantine or isolation period or if you provide a statement from a medical professional stating that you do not have a contagious illness and the symptoms you exhibited are not because of COVID-19.
- You should discuss telework options with your supervisor or submit the appropriate leave.
If you answered “NO” to all questions then you may go to work as planned.

Once you submit this form you will receive an email confirming your response. Thank you for your cooperation.

Your submission of this document is your electronic signature that at the time and date of submission the above documentation is correct to the best of your knowledge.

I have read and acknowledge the statement above.

Yes

Faculty/Staff Contact Information

When documenting your departure, you should list all areas that you accessed during your stay. Please note the departments and offices you visited today.

List the names of those you met where contact was both within six feet and lasted 15 minutes or longer.

Text Super:

First Name:

Last Name:

ctcLink ID:

Phone:

Email Address: