Misconduct Reporting Form
All reports will be taken seriously and investigated. Retaliation against anyone making a good faith report is strictly prohibited.
1. Would you like to submit this report anonymously?
*
Yes, I wish to remain anonymous
No, I would like to provide my name and contact info
2. If not anonymous, please provide:
Name
First Name
Last Name
Email
example@example.com
3. Date and Time of the Incident (If Known):
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
4. Location of the Incident
*
Gym Floor
Treatment Room
Restroom
Front Changing Room
Lobby
Parking Lot
Off-Site
Other
5. Individuals Involved (If Known):
Name(s) or Description
6. What Happened?
*
Describe the Incident
7. Have you reported this before?
*
Yes
No
8. Supporting Evidence (Optional):
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Desired Outcome/Resolution (Optional):
Signature (Optional):
Submit Form
Submit Form
Should be Empty: