Harassment and sexual misconduct incident report

Harassment and sexual misconduct incident report
Thank-you for choosing to report something that has happened. The information contained in this report will only be passed on to those staff members who need to know it. It may seem difficult but providing your contact details will enable us to give you better support and stop something similar from happening to another person.

Choosing to report anonymously means we might not be able to help you directly, or take any formal action against the perpetrator, but it can help us provide support to others and the information given will hopefully inform prevention work within the House.

If you would like to speak to someone, need direct support or guidance, or would like a formal investigation to take place, please add your contact details below.
Name

First NameLast Name
Room number
Email address
example@example.com
Phone Number
Please enter a valid phone number.
This incident happened:

To meTo someone elsePrefer not to say
I would describe what happened as:

Bullying - Offensive, intimidating, malicious or insulting behaviour, an abuse or misuse of power through means which have the purpose or effect of undermining, humiliating, denigrating or injuring the recipient. Bullying usually involves a repeated course of conduct, often in the context of a position of authority or status and may be in person, in writing and/or by electronic meansHarassment - Unwanted conduct related to age, disability, gender reassignment, race, religion or belief, sex, sexual orientation that has the purpose or effect of violating a person's dignity or creating an intimidating, hostile, degrading, humiliating or offensive environment. The unwanted conduct can be physical, verbal or non-verbal.Sexual Misconduct - Sexual misconduct is a form of harassment and can include sexual harassment; sexual violence; intimate partner violence; assault, grooming, coercion or bullying with sexual elements; sexual invitations and demands,comments, non-verbal communication, creation of atmospheres of discomfort, andpromised resources or advancement in exchange for sexual access.RacismSexismAbleismHomophobiaBiphobiaTransphobiaAntisemitismIslamophobiaOther religion or belief-based hateI'm not sureOther
Please provide as many details as you can about the incident.
When did the incident/s start to take place?

Within the last 3 months or lessWithin the last 3-12 monthWithin the last 12 months or more
Where did the incident/s take place? (Tick all that are applicable)

At International Students HouseOn campusIn personOnlineIn publicIn work or study spaceAt a social event
Other (please give details)
Is the person you are reporting:

ISH residentMember of staffFormer residentMember of the publicI don't know
Have you discussed your concerns or the incidents you are reporting with anyone at International Students House?

RoommateFriendResident AdvisorDuty ManagerDean of Student Life
Other (please give details)
Please indicate what outcomes or actions you would like as a result of this report:

No further action, I just want to report itI would like support and advice on the options available to meI would like to make a formal complaint or action to be taken
Other (please give details)
Is there anything else you would like to add about the incident? (e.g. if reporting anonymously, please tell us why)
Should be Empty: