Executive Order Violation Report Form
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Your Name
First Name
Last Name
Your Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Your Email Address
example@example.com
Your Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of person/ business/ establishment/ organization that is in violation of the Executive Order
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Website
Address of business/ establishment/ organization
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date when violation happened
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Time when violation happened
Hour Minutes
AM
PM
AM/PM Option
Please state and specify the violation of the Executive Order they are committing?
Not practicing social distancing.
Participants/Employees are not wearing proper face shield/ face masks.
Social gathering that exceeds the person/participant with the capacity of 150 maximum only.
Minors should not be allowed at public places at all times.
Failure to evaluate customers/workers upon entry that might exhibit COVID-19 symptoms.
No health signs and warning messages from management at the entrance of the facility, building, property.
Failed to require necessary health clearance from employees, participants, and officers of the said organization.
Did not provide seats within the vicinity that are at least six (6) feet apart.
Not sanitizing areas that are mostly crowded during a work cycle or office hours.
Did not place an officer in charge around to ensure that social distancing is being implemented.
Did not provide hand sanitizers to the receiving area of the facility.
Did not provide contactless transaction and business operations.
Did not implement a work from home arrangement as an option for all employees, participants and workers.
Other
Description about the violation
You may upload files such as; Video(mp4,mp3 format), audio, images, supporting documents that will help you prove your claim.
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