PSW Code of Conduct Report Form
Confidentiality Notice
All reports submitted through this form are confidential and reviewed only by the PSW Conduct and Integrity Officer and members of the PSW Code of Conduct Compliance Committee. You may choose to remain anonymous. However, providing your contact information may help us follow up appropriately. All information will be treated with discretion, in accordance with the PSW Code of Ethics and Member Conduct. The Code can be viewed here: https://www.pswi.org/Get-Involved/About-PSW
Note
Because your form responses are encrypted for confidentiality, you will need to complete this form in full and will not be able to save your progress.
Reporter Information
All fields optional
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Do you wish to remain anonymous? Note that anonymity may limit our ability to investigate.
Yes
No
Comments
Report Details
Fill in applicable information that you are willing to disclose
Date of Incident
-
Month
-
Day
Year
Date
Or date range, approximate timeframe, incident dates
Location of Incident (e.g. PSW event, online platform, etc.)
Please describe the incident or concern
People involved (names if known are helpful)
Was anyone else present or aware of the situation?
Yes
No
If yes, please explain
Have you reported this elsewhere?
No
Employer, employer HR
Law enforcement
Other association
Other
Provide details of other reports
Optional - upload supporting documents, screenshots, etc.
Browse Files
Drag and drop files here
Choose a file
These can also be provided in follow-up to a report
Cancel
of
Acknowledgement
By submitting this form, you confirm that the information provided is true to the best of your knowledge and understand that PSW will handle this report in accordance with its Code of Ethics and Member Conduct.
Questions
May be directed to the PSW Conduct and Integrity Officer Sarah Sorum at sarahs@pswi.org
Submit
Should be Empty: