Safety Reporting Form

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Please use this form to report any COVID-19 safety concerns at your school.

For reference, here are resources that you can use to evaluate the standard of safety you should expect in your building:
- The Jefferson Strong Start Plan is available here: https://www.jpschools.org/startstrong
- The State COVID-19 guidelines for schools: https://www.louisianabelieves.com/docs/default-source/ready-to-achieve/ready-to-achieve!-2021-2022-school-operational-guidelines.pdf?sfvrsn=737f6718_4

My concern relates to: *

Check all that apply.

Inadequate enforcement of face covering requirement

Inadequate hand sanitizer

Students aren’t washing or sanitizing hands upon arrival at school, at least every 2 hours, before and after eating, before and after using outdoor play equipment and before exiting school facility

Bathroom issues: inadequate soap or hand sanitizer, no warm water, broken basins

Bathroom not being cleaned multiple times each day

Surfaces aren’t being wiped down multiple times per day and before and after each group

Inadequate latex gloves for employees to use while cleaning

HVAC issues, such as inoperable air-conditioning, inoperable windows, inadequate air circulation

Other:

Required

Tell us about your concern. *

Have you reported this to your supervisor or to Central Office? *

Yes

If you answered yes above, what did they say in response?

Has anyone else witnessed this issue? Who? *

Where do you work? *

Name

First and Last Name

Personal Email

Please provide your personal email, not your work email.

Submit

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