Student & Performer Incident Report
Your safety and comfort at DCC are extremely important to us. Please include all details you are comfortable sharing. If you would like to discuss the incident with a member of the management team please include your name and contact information. This form is for incident reporting only. Please direct all general comments to info@dallas-comedyclub.com.
When did the incident take place?
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Month
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Day
Year
Date
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:
Hour
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10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Did the incident take place during a show or class? If yes, please let us know which show or class.
Show or Class
What is the nature of the incident? Select all that apply
*
Abuse - Sexual, Verbal, Physical, Mental
Anger Issue/Loss of Self-Control
Bullying/Cyberbullying
Drug Posession/Distribution
Drug Use/Abuse
Theft
Harassment/Hostile Environment
Hate Crime/Hate Speech/Discrimination
Inappropriate Language/Gesture/Behavior
Inappropriate Photos/Videos/Graphics
Inappropriate Relationship/Boundary Issue
Other
Please describe the incident to the best of your ability and the extent to which you are comfortable.
*
Who was involved in the incident?
*
Were there any witnesses? Provide any names you are comfortable sharing.
*
Are you comfortable with us reaching out to witnesses?
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Yes
No
Not applicable
Name (optional)
First Name
Last Name
What are your pronouns? (optional)
she/her, he/him, they/them, etc.
Email (optional)
example@example.com
Phone (optional)
(555) 555-5555
Do you want us to contact you? If "Yes" we will do our best to be in touch within 24 hours.
*
Yes
No
I prefer to remain anonymous.
Would you prefer speaking to a male or female staff member?
Male
Female
No Preference
Would you like to provide any other comments?
Submit Report
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