Day of Arrival Guest Screening for Dorm Visits

This form must be completed by every guest* on the day of their arrival. All guests, with the exception of vendors, state auditors or Living Resources employees must be listed on a Request to Visit form previously submitted to and approved by Colleen Dergosits or Kevin Baker.

* A “guest” includes but is not limited to all outside vendors, families, state auditors, office staff, maintenance staff, nursing staff, and any other individual who is not a regular staff person at the residence.

Staff members assisting in screening process need to wear PPE (including gloves and a mask)

Except for vendors, to gain access to a dorm, you must be listed on a previously approved Request to Visit form; answer ‘no’ to questions 1 – 5; and acknowledge you understand you must wear a face mask during your visit.

The ‘Submit’ button will change to red and active when all the above questions are answered and entry approval is granted

You are approved!