Incident Report Form

Incident Report

Please fill out the form below to submit your concern.
Thank you for bringing your concerns to our attention. Your form is anonymous, and confidential, unless you choose to identify yourself.

Once a report is received, HR will conduct a prompt and thorough investigation, and will take corrective action, as appropriate, based on the findings of the investigation.

The more information we have, the better equipped we will be to intervene. However, you are not obligated to report more than you are comfortable.

Please note the following:
1. All parties to an investigation will be treated fairly.
2. Other parties will only be involved on an as needed basis.
3. Where considered necessary or appropriate, the results of an investigation will be reported to the appropriate law enforcement agency.
Name (not required)

First NameLast Name
E-mail (not required)
example@example.com
Phone Number (not required)
On whose behalf are you reporting?

MineSomeone else's
What happened? Please describe the incident(s) in detail. Include time, place, participants, sequence of events, and any relevant contextual details. The more specific you can be, the better.
Have there been prior incidences involving this person(s)? If yes, please describe them.
Have you previously reported or submitted a complaint about this person(s)? If yes, to whom?
If you would like to, please identify any witness(es), or person(s) with personal knowledge or information pertaining to the event(s).
If you have any evidence to support your claim (emails, documentation, recordings, etc), please list them here.
If you have a document to support your claim, please upload it here.

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If you have another document to support your claim, please upload it here.

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Resources
Here are a few other resources available to you for additional support.

Los Angeles Police Department
Commanding Officer: (213) 486-6850 / Special Assault: (213) 486-6910

Women In Film Sexual Harassment Help Line
womeninfilm.org/helpline/
(323) 545-0333

RAINN
rainn.org/ (anti-sexual violence organization)

US Department of Labor Whistleblower form
https://www.osha.gov/whistleblower/WBComplaint.html

California State Auditor Whistleblower Hotline 1-800-952-5665
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