Sexual Assault or Harassment Report
Do you want to be contacted by an ACD SASH Officer or complete an electronic form
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Someone please contact me by phone about this form
Just complete the electronic form
Do you prefer to be contacted by:
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No Preference
Female SASH officer
Male SASH officer
Phone Number
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Is this report for
Yourself
Someone Else (3rd Party)
Do you wish to remain anonymous
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Yes
No
Your Name
*
Do you have this person's permission to disclose this information
Yes
No
Affected person(s) name.
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Has the incident been reported to Police?
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Yes
No
Date of incident:
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Brief description of the incident and any actions you have taken. (If you want to identify or describe the person this report is against, please do so here)
*
Submit
Should be Empty: