Gulf Atlantic Diocese Reporting Form

Gulf Atlantic Diocese Reporting Form
To report an incident of clergy or employee misconduct, please provide the following information. If you have questions, please contact the intake officer by emailing safeguarding@gulfatlanticdiocese.org or calling 904-300-0512.

Thank you for your courage in submitting this form. Please know the intake officer 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, however it may be difficult to follow up on the incident):
Your Title: Mr/Ms/Mrs
Name

First NameLast Name
Name of your church
Your contact number:
Please enter a valid phone number.
Your email:
example@example.com
Name of the accused:*

First NameLast Name
Where does the accused go to church/ which Anglican church is involved?*
Is the accused a:*

Clergyperson?Lay person (not ordained)?
The role/title of the accused:
Phone number of the accused (if known):
Please enter a valid phone number.
Email address of the accused (if known):
example@example.com
What is the nature of the relationship between the reporter (you) and the accused?*
Names of witnesses and their contact information:
All allegations against clergy must claim the breaking of a vow for one of the following reasons (as listed in the Provincial Constitution & Canons of the Anglican Church in North America (Title IV, Canon 2, Section 1). Please choose the charge(s) to which the allegation applies:*

Apostasy from the Christian FaithHeresy, false doctrine, or schismViolation of Ordination Vows (ordination vows for a priest or deacon can by found in the 2019 Book of Common Prayer, available for free online)Conduct giving just cause for scandal or offense, including the abuse of ecclesiastical powerA conviction by a court of competent jurisdiction for felony or other serious offensesSexual immoralityAcceptance of membership in a religious jurisdiction with purpose contrary to that of this ChurchViolation of any provision of the Constitution of this Church (the Constitution is available online)Disobedience to, or willful contravention of the Canons of this Church or the constitution or canons of the Diocese in which the charged or accused member of the clergy holds office (the canons are available online)Habitual neglect of the duties of the charged or accused member of the clergy’s officeWillful refusal to follow a lawful Godly Admonition (Godly Admonitions are given by the Bishop)Other
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). Be sure to provide the connection between the allegation and the canonical charge (listed in the question above). If you would prefer, you may upload a summary document below. *
Upload File
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 is to bring this situation into the light, not to investigate.
Further comments (optional)
Please confirm:*
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 intake officer will ensure that you stay informed of the resulting steps throughout the process.
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