Covid-19 Workplace Safety Complaint Form

Personal Information

I would like to remain anonymous.

If you would like us to follow up with you regarding this matter, please include your contact information:

First Name

Last Name

Phone Number

Email

Site Information

Building (*required)

Department (*required)

Supervisor Name

Complaint

Please describe your complaint in detail including the location, safety matter involved (i.e. mask use, signage, etc.), or additional information to help us investigate. (*required)

John Jay College

Covid-19 Workplace Safety Complaint Form

Data Collection Form

I would like to remain anonymous.