Purpose of This Form

Advocacy: To assist in advocating for those who have experienced traumatic situations by providing necessary support, follow-up, and treatment with sensitivity and care. This form helps ensure that the person who was affected's needs are prioritized and addressed in a compassionate and effective manner, incorporating restorative practices to promote healing and resolution.

Response: To aid rangers, event coordinators, medical personnel, and the community in responding to and following up with incidents in a trauma-sensitive manner. This form serves as a critical tool for organizing an appropriate and timely response to support the person who was affected and address the incident. Additionally, this form helps to facilitate restorative practices, ensuring that the needs of the affected individuals are prioritized and that the community can work towards healing and resolution.

Education: To document and log incidents, providing the Burner CARE Committee with insights into areas where the burner community needs education, advocacy, and attention. This information helps identify patterns and areas for improvement, guiding the development of educational programs and advocacy initiatives to enhance community safety and awareness. Restorative practices will be integrated into these efforts, promoting a holistic approach to addressing harm and fostering a supportive and resilient community.

 
What to Expect When Completing This Form

When you complete this form, you will be asked to provide various information to help us accurately document and respond to the incident. Here’s a breakdown of what to expect:

 

Basic Information: The requested information includes your name, contact information, and other relevant details.

 

Depending on your role, additional questions will vary:

 

• As a Person Who Has Been Harmed: Questions asking how you want to be supported and followed up with. Information about the incident. Choose this option even if you have a friend/support person helping in completing this form. 

• As a Friend/Witness: Information about the incident 

• As a Ranger, Medic, Lead, or Event Coordinator (EC): Information about the incident. Follow-up questions include how the incident was supported/resolved and details about implementing survivor support.

 

Confidentiality and Privacy Notice:

The information provided in this report will be treated with confidentiality and respect. All personal details and descriptions of the incident will be kept private and shared only with necessary persons, such as Event Coordinators (ECs), Leads, Medic and Rangers. 

We are committed to protecting privacy and ensuring information is handled sensitively and carefully. We aim to provide support, ensure safety, and take appropriate action while maintaining confidentiality.

 

By completing this form, you acknowledge that:

• The information provided will be used for Advocacy, Response, and Education, as described above under the purposes of this form.
  
• The personal and identifying information the person who was harmed shares will only be disclosed with consent, discretion, and sensitivity where necessary to respond to reported incidents and prevent future harm. 

• General information, including the Person Who Harmed's Identifying Information, may be disclosed with discretion and sensitivity where necessary to address incidents or prevent immediate harm.

You are not alone, and this was not your fault.

The community is here to support you. If you would like assistance in completing this form, someone from Burner CARE can schedule a time to meet with you via video or over the phone to offer support.  You can fill out as much or as little as you are comfortable with, and you can complete it whenever you are able to and at your own pace.