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Grant Elementary Compliance for Safety Protocols
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* Indicates required question
Email
*
Your email
Last Name, First Name
*
Your answer
Location of Concern: Building, Room #, etc.
*
Your answer
What is the nature of your concern?
*
Masking
Social Distancing
Cleaning/Disinfecting
Lack of proper safety supplies (soap, paper towels, cleaner, PPE, etc.)
Screening Protocol
Other:
Supplies/Site Concerns
Fill out the below questions if the concern is about materials/supplies, ventilation or cleaning.
If Materials/Supplies are needed and were not provided by site staff in a timely manner, please identify needs:
Hand Sanitizer Refill
Cleaner/Disinfectant
Towels
Hand washing soap
Toilet Paper
Other:
If ventilation is the concern, please identify needs:
HVAC needs repair
Windows do not open
Other:
Clear selection
If timely cleaning of your classroom is the concern, please identify needs:
Surfaces not wiped down
Sink not cleaned
Other:
Clear selection
Employee/Person on Site
Fill out the questions if the safety concerns are raised by a staff member or person on site.
Name the person whose actions are concerning.
Your answer
Date of incident:
MM
/
DD
/
YYYY
Please provide a short description of the incident(s) and to the best of your knowledge, any previous interventions that have taken place.
Your answer
A copy of your responses will be emailed to the address you provided.
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