Sick Tray Request Form printable pdf download

Sick Tray Request Form

Student requesting meals please fill out this part:

Name:________________________________________

Hall:__________________________________________

Room Number:_________________________________

Phone Number:_________________________________

Date:_________________________________________

Meal requested: breakfast

lunch

dinner (please circle one)

Please fill out top of form and give your ID card to the person picking up your

food. This is good for only one day of meals.

Student picking up meals for sick student please fill out this part:

Name:________________________________________

Hall:__________________________________________

Room Number:_________________________________

Phone Number:_________________________________

You will need to show your ID and bring this form, along with the sick student’s

ID card, to the cashier at the dining hall. This service is valid at either the SUB

or Hasbrouck Dining hall during regular scheduled meal times.

Dining Hall/Food Service Staff receiving this form, fill out this part:

Date:______________________________

Time:______________________________

Location:___________________________

Staff initials:_________________________

Please check the students ID card (who is picking up the meals) and indicate the

time, date, location and initial verifying the ID of person picking up the food. If

student is picking up food at the SUB please attach receipt to this form. This

form will be collected every Monday and given to Residence Life to check if

student was sick.

If a student is found abusing this protocol in any way, judicial action

will be taken.

Sick Tray Request Form