Report a COVID-19 Related Concern

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Your Name*:
Your Email*:
Your Phone Number:	( ) - Second three digits Last four digits
Business Name of Concern*:
Business or Location Address*:
Concerns:	Health and Safety concerns in high-risk settings (Healthcare Facilities, Homeless Shelters, Emergency Shelters, Corrections, Public Transit, Long-Term Care Facilities) COVID-19 safety concern regarding health care or dental provider Other - provide details below
Describe COVID-related concern*:

COVID-19 Resources