GB Ethics: Incident Report

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In What Country Are You Reporting From?* This field is required.
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What Country Are You Reporting From? * This field is required.
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In What Country Did The Issue of Concern Occur?* This field is required.
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In What Country Did The Issue of Concern Occur?* This field is required.
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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
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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
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Is it your wish to remain anonymous in this report?* This field is required.
YESNO
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Is it your wish to remain anonymous in this report?
Please Select
Please Select
Yes
No
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What is Your Name?
First Name
Last Name
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What is your Email Address?* This field is required.
example@example.com
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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
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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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Identify any witnesses or other individuals who may be able to provide additional details on this issue.
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Do you have any reasons to believe a manager or direct supervisor is involved in the issue of concern?* This field is required.
YESNO
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Do you have any reasons to believe a manager or direct supervisor is involved in the issue of concern?* This field is required.
Please Select
Please Select
Yes
No
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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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Please provide an accurate description of the issue of concern* This field is required.
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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.
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Is this an ongoing issue?* This field is required.Did it occur multiple times or only once?
YESNO
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Is this an ongoing issue?* This field is required.Did it happen more than once?
Please Select
Please Select
Yes
No
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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
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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
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If other, please detail how you have been made aware of this issue of concern
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If any persons attempted to disguise this issue of concern, please cite their names and actions to conceal it.
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If you have evidence or proof that supports your report, please upload it here.
Drag and drop files here
Select files to upload
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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Before submitting this Gracie Barra Safety and Ethics Incident Report, please read and acknowledge the following:* This field is required.
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