West Side School COVID-19 Public Health Complaint Form

Please complete the form as accurately and completely as possible. Describe each area of concern in as much detail as you can, including location at the worksite. If there is any evidence that supports your suspicion that a hazard exists (for instance, a recent accident or physical symptoms of employees at your site) include the information in your description.

Thank you for your feedback.

Your relationship to West Side School*

Answer required for "Your relationship to West Side School"

Currently work at West Side

A friend or family member works at West Side

My child attends school or receives services at West Side

In my community

No established relationship

Describe the concern which you believe exists. Include any specific details you feel are pertinent for a follow-up investigation. *

Answer required for "Describe the concern which you believe exists. Include any specific details you feel are pertinent for a follow-up investigation. "

Has the superintendent/principal been notified about these concerns? *

Answer required for "Has the superintendent/principal been notified about these concerns? "

Yes

Not sure

Has Public Health been notified about these concerns? *

Answer required for "Has Public Health been notified about these concerns? "

Yes

Not sure

If you would like to be contacted about this complaint, please provide a phone number or email.

Answer required for "If you would like to be contacted about this complaint, please provide a phone number or email. "

Please fix the highlighted areas below before submitting.

West Side School COVID-19 Public Health Complaint Form