Online Form

PSC Report Form for CUNY H1N1 Preparedness

This form is for PSC members to report the H1N1 preparation conditions on their campuses. Members can report on one bathroom and/or the posting of signs per form. Once you complete it, you will be prompted to fill it in again for each additional bathroom or you wish to report.

If you have questions or problems on your campus, call the PSC Health and Safety Watchdogs at (212) 254-1252. If you have problems with the form, call PSC Communications Coordinator Dania Rajendra, (212) 354-1252 or email her at drajendra@pscmail.org.

* Your name

* Your email address

* Your campus

* The location you're reporting on (building, floor, department, office, area, etc.)

* Are hand sanitizers widely available on your campus?

Yes No

If so, please let us know where

The bathroom-specific questions appear first. Please scroll down for questions about the posting of signs.

Bathroom

Men's Room Women's Room

Bathroom location (building name, floor, etc.):

Is there soap in all dispensers?

Yes No

Is hot water available?

Yes No

Is there an adequate supply of towels or are all hand dryers functioning?

Yes No

Are best-practices hygiene signs posted?

Yes No

Questions about the posting of signs.

Are the hours of the Health Services office posted throughout the campus?

Yes No

Are there signs about covering coughs and sneezes posted throughout the campus?

Yes No

Are there signs about flu symptoms and what to do posted throughout the campus?

Yes No