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COVID-19 Incident Form

This form is for non-emergency reporting of behaviors involving student(s), organizations or employee(s) that do not promote a healthy and safe community during the coronavirus pandemic. Questions, concerns and other inquiries regarding Elmira College's Reopening Guidelines and protocols can be directed here as well.

If you need to report an emergency or are reporting an incident that poses an imminent risk of harm, call Campus Safety at (607) 735-1777, or dial 9-1-1.

Elmira College is committed to creating a safe working and learning environment for the entire campus community. In turn, it is imperative that everyone do their part to follow the guidelines put into place - not only to help ensure that we can maintain in-person classes this Term, but also for the health and safety of your friends and co-workers.

Upon receipt of this report, the matter will be reviewed and proper steps taken to address the concern in accordance with Elmira College policies and procedures. Reporters and involved individuals, organizations or groups listed may be asked to meet with a staff member to provide additional information. When submitting this report, please be accurate and include as many details as possible. While this report cannot be submitted anonymously, the identity of those listed will be kept as confidential as possible.

If you want to self-report a positive coronavirus test or share information for potential contact with someone who has tested positive, please email covid19@elmira.edu. Per HIPAA regulations, all health-related information remains confidential.

Please note that this form may not be reviewed outside of normal business hours.

REPORTER INFORMATION

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INVOLVED INDIVIDUALS, ORGANIZATIONS OR GROUPS

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DETAILS

Please provide a detailed description of the incident/concern using specific, concise, objective language (who, what, where, when, why, and how). If you are asking for a clarification regarding the policy, a question, or are expressing a general concern, please be specific about your concern.

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Is there anyone else who has knowledge of this incident, or that we should speak with regarding this concern? If so, provide their name and contact information here if they were not included in the Involved Parties section above.


SUPPORTING DOCUMENTATION

Photos, video, email, and other supporting documents may be attached below. Attachments require time to upload, so please be patient after submitting this form.