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COVID-19 Staff Counts

  1. Instructions

    Please complete this form for each staff member who has been physically displaced from their typical work area pursuant to recommendations regarding COVID-19.

  2. Your name

  3. Information About Displaced Employee

  4. Division *

    What division does the employee work under?

  5. Reason for Displacement*

  6. Choose the Employee's Job Title Under Their Respective Division

  7. Employee's Job Title (ADMIN)

  8. Employee's Job Title (PATROL)

  9. Employee's Job Title (911 DISPATCH)

  10. Employee's Job Title (EM)

  11. Employee's Job Title (SUPPORT & SERVICES)

  12. Employee's Job Title (Jail)

  13. Enter a number

  14. Working While Quarantined?*

  15. Essential Service Employee?*

    Indicate if the employee falls under any of these categories classified as providing critical life-safety services:

  16. Status of Essential Service Employee*

    Status of ability to perform essential functions

  17. Additional comments about this employee that could be helpful for tracking purposes. Also specify what type of leave if "Other" was selected above.

  18. Leave This Blank:

  19. This field is not part of the form submission.