Your Name?
*
First Name
Last Name
Your location?
*
Location #1
Location #2
Location #3
In what category do you have concerns?
*
Discrimination
Harassment
Inappropriate Behavior
Policy Violation
Other
What type of discrimination?
Race
Religion
Gender
Age
Disability
Other
What type of harassment?
Bullying
Sexual
Threats
Other
What type of inappropriate behavior?
Jokes
Touching
Images
Other
What type of policy violation?
Drugs/Alcohol
Smoking
Appearance
Fraternization/Nepotism
Visitors
Safety
Conflict of Interest
Weapons
Theft
Timeclock
Technology
Other
Please list the name of any and all parties involved?
*
Please describe exactly what happened?
*
When did this occur?
*
-
Month
-
Day
Year
Date
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Is it still ongoing?
*
YES
NO
Please describe in detail what is still happening. Please list all dates and times.
Are there any witnesses?
*
Any additional information?
SEND
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