COVID19 Incident Reporting Form


The VLS community has a shared responsibility to act in ways that reduce the potential spread of COVID-19 and to abide by the safety measures and policies put in place by the One VLS Action Team (OVAT). If a community member observed that an individual or group is not acting responsibly with regard to the COVID-19 policies, these incidents can be reported through this form. It is recommended that you first report concerns to a supervisor, dean, member of the administration or directly to the OVAT by emailing covid19@vermontlaw.edu. However, this form presents an additional reporting option for individuals who may not be comfortable reporting in those methods. Note: The full contents of this report will be made available to the person who allegedly violated the policy.
* = is required Background Information
Full Name:
I am a:	*
Position/Title:
Phone Number:
Email Address:
Date of Incident:	*
Time of Incident:
Location of Incident:	*
Incident Details
Please provide a detailed description of the incident/concern using specific concise, objective language. Be sure to include who, what, where, when, and how.
Is this incident related to a violation of the Return to Campus Health and Safety Protocols?	*	No Yes, not wearing mask(s) Yes, refused to wear masks(s) after being asked Yes, removed mask(s) Yes, refused to maintain physical distancing Yes, more people allowed in a room Yes, large outdoor gathering Yes, unauthorized access to campus or a prohibited area
If not already written in the description, please specify which violation(s) occurred and by whom.
Number of People Present:
Supporting Documentation Photos, video, email, or other supporting documents may be attached. (JPG, MP4, PDF, DOCX only please)