Anti-Violence and Harassment Online Complaint Report Form

Are you reporting for yourself or someone else?*

For myselfFor someone else

Name*

Write "Anonymous" if you do not wish to identify yourself. If you submit this form anonymously, please note that it may affect our ability to investigate and follow up.

Your contact information*

Email, phone, or other preferred method of communication

Where did the incident happen?*

Be as specific and detailed as possible, including what type of unacceptable behaviour took place (what the alleged offender said or did), date(s)/time(s), who was involved, how it happened, etc.

If there are witnesses, please describe below with as much identifying information as possible, including contact information.

Did you tell anyone about your experience after the alleged incident (co-participant, ITUC-AP staff, etc.)? If so, please provide the name(s), date, and contact information of whomever you spoke.*

What do you want the next step to be? Check all that apply.*

I wish to be contacted so that I can learn about the available support measures and resources available to me.I am submitting this report to request an investigation into this incident.I am filing this report on behalf of another individual who may be contacted.Other, please specify.

Is there any additional information or concerns you would like to share?*

If you have supporting documentation that you would like to include with your submission, please attach them here. This may include any or all of the following: photos, video, emails, recordings, screen shots, text messages, and other materials.

By submitting this report, I understand that:

It will be sent directly to the ITUC-AP Anti-Violence and Harassment Committee and that they may seek additional information from me related to the incident(s) detailed within this report.

The Committee will seek to contact the Complainant as a result of this report to ensure the Complainant’s access to all of the available support services and options afforded to them.

The information contained within the report is accurate based on the knowledge I have and is being provided in good faith.