COVID-19 Complaint Form

COVID-19 Complaint Form
This form is to be used to submit a formal complaint against a person or University affiliated organization on campus that does not follow the expectations outlined by the University with regard to protecting the health and safety of all community members during the COVID-19 pandemic. The most up to date information can be found at https://www.albany.edu/covid-19.

This form is not intended for use in emergency situations or for an immediate/live response.

If this matter is an on-campus emergency, please immediately call the University Police Department at 911 from a campus phone, or (518) 442-3131 from a cell phone. To report off-campus emergencies dial 911 to be connected with the appropriate police agency or emergency services.

Additionally, to report a non-emergency incident in the Residence Halls or University Apartments that requires an immediate response, please call the respective living area (available 24 hours, 7 days a week, when halls are apartments are open):
- Indian Quad (518) 442-5940
- Dutch Quad (518) 442-5900
- Colonial Quad (518) 442-5911
- State Quad (518) 442-5920
- CrestHill Suites Temporary Housing (518) 337-6352
- Empire Commons (518) 956-6250
- Liberty Terrace (518) 956-8300
- Freedom Apartments (518) 442-5830
Report Routing:
- Reports against students will be sent to Community Standards, Office of the Dean of Students.
- Reports against faculty or staff will be sent to Employee Relations.
- Reports against University affiliated organizations, such as student groups/organizations, will be sent to the Office of the Dean of Students and Student Involvement (and forwarded as appropriate).
- Reports against visitors or non-community members will be sent to the University Police Department
Reporter's (Your) Information

Please strongly consider providing your name and contact information. This will allow us to contact you for clarification or for any additional information that may be necessary to appropriately review and/or address your complaint.
Reporter's Affiliation; I am a: *

Faculty Member Staff Member Student Visitor/Non-Community Member
Name *

First Name (or anonymous) Last Name (or anonymous)
To submit a report anonymously, type "anonymous" in this box. Anonymous reports may limit the extent to which the University is able to investigate and/or address the complaint. Please give as much detailed information as possible on this form as we cannot follow up with you.
Reporter's University ID#
Example: 001234567
Phone Number

Area Code Phone Number
Email
example@example.com
Information About the Person/Organization Being Reported
Type of person/organization being reported *

Student Faculty/Staff Member Visitor/Non-Community Member/Unknown University affiliated organization (such as, student group/organization)
Name of person being reported *

First Name Last Name
If the name is unknown, write "unknown" in First and Last Name boxes. Then, in the below "Description of Incident" box, please describe the unknown individual.
Name of Organization
If the name of the organization is unknown, write “unknown” in the box and then describe the organization in the “Description of Incident” box below.

Additionally, if you can identify individuals involved, in the below “Description of Incident” box, please also include the individual’s names, and if known, their phone numbers, email addresses, and University ID#’s.
Person's University ID# (if known)
Example: 001234567
Person's Phone Number (if known)

Area Code Phone Number
Person's Email (if known)
example@example.com
Information About the Incident

If there are multiple dates/times please note the first date below and include the additional dates in the "Description of Incident" section below.
Date of Incident *

Month Day Year
Date Hour Minutes AM/PM Option
Location of Incident *
Please provide a detailed description of where the incident(s) took place (i.e. exact address, residence hall building/room, location within the home, etc.)
Witness(es)
Name(s) of Individual(s) who witnessed the incident(s). Please include witnesses’university ID, and contact information if available.
Description of Incident *
Please provide a detailed description of what occurred. What COVID-19 policy was violated? What steps, if any, did you take to address the behavior?
Supporting Documentation

Browse Files
Attach/UploadDocuments here. Please upload any documents, pictures, videos, text messages,emails, etc. regarding the incident. Cancel of
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COVID-19 Complaint Form

Reporter's (Your) Information

Information About the Person/Organization Being Reported

Information About the Incident