Safety Reporting Form
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:
- The State COVID-19 guidelines for schools:!-2021-2022-school-operational-guidelines.pdf?sfvrsn=737f6718_4
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My concern relates to: *
Check all that apply.
Tell us about your concern. *
Have you reported this to your supervisor or to Central Office? *
If you answered yes above, what did they say in response?
Has anyone else witnessed this issue? Who? *
Where do you work? *
First and Last Name
Personal Email
Please provide your personal email, not your work email.
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