Language Access Incident Report Form

The Language Access Coalition is collecting examples of language access violations.

Please use this form to share details about incidents that may be examples of language access violations -- even if you are unsure of whether there has been a violation of law.

We hope to use this data in different ways, including legislative advocacy and spreading awareness of problematic behaviors, with the goal of improving language access compliance in Massachusetts.

Please do not include any personally identifying details about clients, such as social security numbers, addresses, etcetera.

Conatc Iris Coloma-Gaines at MLRI, icoloma-gaines@mlri.org, if you have any questions.

Thank you.

Date of incident

Month

Day

Year

Name of Court/ Agency/ School where incident occurred *

Name(s) and Position(s) of Person(s) from Agency/ Court/ School involved in incident

Describe incident *

Was any complaint and/or report made about the incident? *

Yes

Not sure

If yes, to whom and when?

If a complaint and/or report was made, what was the outcome?

Favorable

Unfavorable

Other . . .

If a complaint and/or report was made, what was the outcome? Other . . .

Please provide more details about the outcome

Your name *

Your email *

Comments?

Leave this field blank

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Language Access Incident Report Form