Vermont Law School

COVID19 Incident Reporting Form

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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 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.

Background Information

Full Name:
I am a:
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)