COVID Concerns Alert Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

If you see something, say something.
Use this form to notify us about any issues you are having in regard to the Fall 2020 semester. Our goal is to meet the needs of all students, staff members, and guests in these challenging times.

Your First Name *

Your Last Name *

Contact Information *

The Best Way to Contact Me *

Phone

Do Not Contact Me

Required

Are you reporting for yourself or someone else? *

Myself

Someone else

Were you in close contact with a covid positive individual? (Less than 6 feet apart for 15 min or more over a 24 hour period.) *

Are you, or the person being report, Fully Vaccinated for COVID-19? *

Yes

Partial (1 of 2 completed)

I don't know. I'm not reporting for myself.

Do you have any questions or concerns? *

If reporting a positive COVID result, when and where were you last on campus?

What Resolution Would You Like?

Thanks for Sharing!

Your report will be directed to a DACC Administrator for immediate assistance.

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Danville Area Community College. Report Abuse

Forms