REPORT COVID SAFETY CONCERNS

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This form is to anonymously report concerns regarding community members not following the COVID safety guidelines. For example: someone who is not wearing their mask in the building, not socially distancing appropriately, coming in the wrong entrance, etc. Your email address will not be recorded. Because this is anonymous, we will handle the incident but you will not receive a response unless you choose to share your name and contact information at the end of the form.

Date the Incident Took Place *

YYYY

Time of the Incident *

Time

Location of the Incident *

Name of the Person that you are reporting, or a specific description of who they are if you do not know their name. *

Details about the Incident (briefly explain what took place) *

This is an anonymous report. If you would like to share your name and contact information so that we can follow up with you, please do so below.

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