GB Ethics: Incident Report

1
In What Country Are You Reporting From?* This field is required.
2
In What Country Did The Issue of Concern Occur?* This field is required.
3
What is The Name of The Gracie Barra School The Issue of Concern Occured?Please add the full name of the Gracie Barra School including City, State / Province, and Country
4
What Is your relationship with Gracie Barra?* This field is required.
Student
Parent (or guardian)
Staff Member
Instructor
School Owner
Not a Gracie Barra Team Member
5
Is it your wish to remain anonymous in this report?* This field is required.
YESNO
6
What is Your Name?
First Name
Last Name
7
What is your Email Address?
example@example.com
8
What is your phone number?Please add a phone number registered with global communication services such as Imessage, WhatsApp, or Telegram
Country Code
Area Code
Phone Number
9
Please list the person or persons who directly engaged on this behavior* This field is required.Please ad first name, last name, and the role each individual plays within the team.
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10
Identify any witnesses or other individuals who may be able to provide additional details on this issue.
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11
Do you have any reasons to believe a manager or direct supervisor is involved in the issue of concern?* This field is required.
YESNO
12
If you can, please identify any one else within Gracie Barra who has been made aware of this Issue of Concern
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13
Please provide an accurate description of the issue of concern* This field is required.
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14
What is the location in which this incident took place?* This field is required.Please specify if it was within the premises of the school, online or anywhere else.
15
Is this an ongoing issue?* This field is required.Did it occur multiple times or only once?
YESNO
16
When did the issue of concern happened?* This field is required.If this is an ongoing issue, please ad the date (and time, if possible) of the most recent incident
17
How did you become aware of this issue of concern?* This field is required.
It happened to me
I saw It
I heard about it
Other
18
If other, please detail how you have been made aware of this issue of concern
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19
If any persons attempted to disguise this issue of concern, please cite their names and actions to conceal it.
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20
If you have evidence or proof that supports your report, please upload it here.
Drag and drop files here
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Max. file size: 10.6MB
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Please provide any additional details regarding this issue of concern that may be useful in its assessment and resolution
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