Sexual Harassment Reporting Form

Sexual Harassment Reporting Form

Use this form if you believe you have experienced or seen sexual harassment or at one of our events, workshops or labs and would like to lay a complaint. This report will be treated confidentially.
Name

First NameLast Name
When did it happen?

DayMonthYear
Date
Time

:HourMinutesAM/PM Option
Please provide details of the incident, for example:
- Where did it occur?
- Who was present?
- What was said or done? Who by? What’s their position?
- Who witnessed this incident?
- How has this incident affected you?
- Have you taken any actions? If so, what?
- What would you like to happen next?
Enter details below:
Please acknowledge the following:*

I understand that I can seek help to complete this form.I declare to the best of my knowledge the information provided in this form is true and correct.
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