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COVID-19 Campus Safety Policy Concern
This form is used to report behaviors inconsistent with or in violation of Brown's COVID-19 Campus Safety Policy. Note that this is not a 911 emergency service. In an emergency, contact Brown University Public Safety at 401-863-4111 from any campus location. The University will do its best to look into the concern, and any information provided on the form will be used to inform communication around the COVID-19 Campus Safety Policy. If the information is not detailed, it may affect Brown's ability to review the specific matter reported.
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* Indicates required question
To report a concern about an undergraduate student, graduate student, or medical student, please click the link below:
https://cm.maxient.com/reportingform.php?BrownUniv&layout_id=19
To report a concern about a staff, faculty, or other member of the Brown community, please continue below. You do not need to include your first or last name, email address, phone number, or relationship to Brown on this form.
Your first name:
Your answer
Your last name:
Your answer
Your email address:
Your answer
Your phone number:
Your answer
What is your relationship to Brown?
Staff member
Faculty member
Undergraduate student
Graduate student
Medical student
Postdoc
Other:
Clear selection
Type of concern you are reporting (check all that apply)
*
Mask/face covering
Social distancing
Hygiene concern
Large gathering
Theft of supplies (PPE, cleaners)
Other:
Required
Who was involved in the concern you are reporting? (check all that apply)
*
Staff member
Faculty member
Contractor/Vendor
Unknown
Other:
Required
Can you identify the Brown University community member, contractor (company name), etc., regarding the concern you are reporting? If yes, and if known, please list details, such as name, department works in, below. If not, please list "no".
*
Your answer
How did you become aware of this violation?
*
It happened to me
I observed it
I heard it
I was told by a Brown University community member
I was told by someone outside of Brown University
I do not wish to disclose
Other:
List the date(s) and time(s) this occurred:
*
Your answer
List the location, building, floor, room number, outdoor location, etc., where this occurred:
*
Your answer
Provide a brief description of the concern you are reporting as well as any additional details that were not previously covered above and could be valuable in reviewing this matter.
*
Your answer
Have you reported this concern to a supervisor (for employees) or other University official? If so, please list name and department.
*
Your answer
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