Gulf Atlantic Diocese Reporting Form

Gulf Atlantic Diocese Reporting Form

To report an incident of clergy or employee misconduct, please provide the following information. You may also choose to contact an external responder by emailing safeguarding@gulfatlanticdiocese.org or calling 904-300-0512.
Thank you for your courage in submitting this form. Please know the external responder receiving this will take it seriously and respond to you promptly. For that reason, we encourage you to identify yourself to ensure advocacy on your behalf.

We will maintain confidentiality except where required by law or in order to enable the diocese or law enforcement to complete a thorough investigation.

Please include as many details as possible for each violation (number additional violations):
- Who- include the names of all involved including additional contractors or businesses
- What- what are the details of the incident, including specific policies or laws that were broken
- Where- where did the incident take place
- When- times/dates of the incident
- Why- if known, to the best of your ability, what do you assume are the suspect's motives
- How- how was it possible to happen; were there usual policies that were bypassed or a lack of supervision
Thank you for bringing this incident into the light. You may be called upon to assist in the investigation, if required.
Reporter's name (your name; this section may remain anonymous if preferred):

Mr/Ms/MrsFirst NameLast Name
Name of your church:
Reporter's contact number:
Please enter a valid phone number.
Reporter's email:
example@example.com
Suspect's name:*

Mr/Ms/MrsFirst NameLast Name
Suspect's church:*
Suspect's role/title:*
Suspect's contact number:
Please enter a valid phone number.
Suspect's email:
example@example.com
Witness' name (if any):

Mr/Ms/MrsFirst NameLast Name
Witness' contact number:
Please enter a valid phone number.
Witness' email:
example@example.com
What is the nature of the relationship between the reporter and the suspect?*
Briefly describe incident details (who, what, where, when, why, how; if there is more than one violation, please number them and include dates of each incident):*
To the best of your ability, please describe where an investigator might find evidence or documentation of the incident. Do not attempt to locate evidence. Your role as a reporter is to bring this situation into the light, not to investigate.
Further Comments
Please confirm:*

I certify that the above information is true and correct to the best of my knowledge.
Thank you so much for submitting this report.

In any reporting situation, the Gulf Atlantic Diocese's priorities are communication and care to all parties involved. Our external responder will ensure that you stay informed of the resulting steps throughout the process.
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