Incident Reporting Form

1
Urgency

This report is confidential and details will not be shared outside of those who are directly responding and as necessary.
If this is an emergency, stop and immediately call 911 or your local emergency response telephone number (complete this form once the emergency has been addressed).
2
Is this an emergency?* This field is required.
Yes - immediately call 911 or your local emergency response telephone number (𝘤𝘰𝘮𝘱𝘭𝘦𝘵𝘦 𝘵𝘩𝘪𝘴 𝘧𝘰𝘳𝘮 𝘰𝘯𝘤𝘦 𝘵𝘩𝘦 𝘦𝘮𝘦𝘳𝘨𝘦𝘯𝘤𝘺 𝘩𝘢𝘴 𝘣𝘦𝘦𝘯 𝘢𝘥𝘥𝘳𝘦𝘴𝘴𝘦𝘥)
No
3
Your Contact Information

This report is confidential and details will not be shared outside of those who are directly responding and as necessary.

If you wish to remain anonymous, please enter "N/A" for the questions in this section. Please note, if we cannot identify you and we are not able to talk with you about the alleged behavior or situation, it will make it more difficult to investigate.
4
Your Name* This field is required.If you wish to remain anonymous, please enter "N/A" for the questions in this section. Please note, if we cannot identify you and we are not able to talk with you about the alleged behavior or situation, it will make it more difficult to investigate.
5
Your Email* This field is required.If you wish to remain anonymous, please enter "N/A" for the questions in this section. Please note, if we cannot identify you and we are not able to talk with you about the alleged behavior or situation, it will make it more difficult to investigate.
6
Your Phone Number (including country code)* This field is required.If you wish to remain anonymous, please enter "N/A" for the questions in this section. Please note, if we cannot identify you and we are not able to talk with you about the alleged behavior or situation, it will make it more difficult to investigate.
7
Information about Alleged Incident

This report is confidential and details will not be shared outside of those who are directly responding and as necessary.

In order for us to investigate and respond to this report, please answer the questions below to the best of your knowledge/ability. If you don't know, or the question is not applicable, enter "N/A".
8
On what date did this occur? (format: DD/MM/YYYY) * This field is required.
9
Approximately what time did it occur?* This field is required.
10
In what time zone?* This field is required.
11
What is the name of the individual(s) you are reporting about?* This field is required.
12
What type of event was occurring when the alleged incident took place?* This field is required.
In-Person Meeting/Event
Virtual Meeting/Event
Email Exchange
Telephone Call
Members-Only Discord
Other
Other
13
If you selected "Other" in the previous question, please describe event.* This field is required.If the question is not applicable, enter "N/A".
14
What information would you like to report about? Give as much detail as possible.* This field is required.
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15
How were you made aware of this alleged incident? (if situation happened to you, enter "self").* This field is required.
16
Were there any witnesses?* This field is required.
Yes
No
Type option 3
Type option 4
17
Enter names, titles, positions, and contact information of any witnesses (enter "N/A" if there were no witnesses).* This field is required.
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18
What resolution would you like to see regarding this matter?* This field is required.
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Ok
19
Please enter any other information about the alleged incident that you have not already entered and would like us to know about.* This field is required.
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