COVID-19 Safety Report Form

COVID-19 Safety Report Form

If you see what you believe is a violation of the Jefferson County Schools COVID-19 Safety Protocol you can use this form to anonymously report the offense.


1. School/Department where you work:

2. Please indicate the type of violation you observed:

3. Describe the incident with as many details as possible and be specific with location, names, dates, and times.

4.  How are you aware of this incident?

5.  If you answered "other" to the previous question, please describe how you were made aware of the incident:

6.  Your Name 

7.  Your Contact Phone Number

8.  Your Email

9.  Would you like to be contacted about the incident being reported?

10.  If you would like to be contacted, which method would you prefer?



Security Measure

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