LCEA COVID & Safety Concerns Report Form
This form is for LCEA members and potential members to report information to LCEA Leadership about Safety Protocol concerns.
Sign in to Google to save your progress. Learn more
Current Status *
First Name *
Last Name
School/worksite
Non-Work Email *
Personal Phone number
Area of concern *
Is this issue or concern happening to anyone else at your site? *
Has there been any administrative response to this area of concern? *
Please give a brief description of any details or concerns not listed: *
Please report the number (THIS SHOULD BE NUMERIC EX: "4") of students or staff members that you are aware of that have tested positive &/or has been quarantined at your site this current time. (IF YOU DO NOT KNOW LEAVE THIS BLANK)
If you answered the question above, how do you know this information?
Are you willing to work with educators to make learning conditions safe? *
Are you comfortable sharing this information with your building representative?
Clear selection
Do you need assistance in contacting your building representative?
Clear selection
Are you receiving the emails from LCEA currently (LCEA Connects & Newsletters)?
Clear selection
Are you a member of the private LCEA Facebook group? www.facebook.com/groups/lakecea/
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy