• CRRIC Confidential PSEAH and Safeguarding Reporting Form

    Reports may be submitted anonymously. Name, email, phone, and other identifying details are not required. Reports are handled confidentially on a need-to-know basis. CRRIC follows a survivor-centred approach, retaliation is prohibited, and this form is not an emergency service.

  • Reporter information

  • Would you like to make this report anonymously?
  • Your relationship to CRRIC
  • Is it safe for CRRIC to contact you using the information provided above?

  • About the report

  • Which best describes why you are making this report?*
  • What type of concern does this report involve?*

  • Person or people affected

  • Who was affected?*
  • Is any person affected under 18?*

  • Person whose conduct is being reported

  • Do you know the identity of the person whose conduct is being reported?*
  • Does this report concern CRRIC's PSEAH Focal Point, Executive Director, a Board member, or another person who may normally be involved in handling a complaint?*

  • What happened

  • Date of incident or conduct
     - -
    2 digit month, 2 digit day, 4 digit year
  • Did this happen more than once?
  • Where did the incident or conduct occur?

  • Witnesses and supporting information

  • Did anyone else witness the incident or have information about what happened?
  • What information or records may help us understand the concern?

  • Previous reporting

  • Has this concern been reported to anyone before?

  • Support

  • Should CRRIC help connect you or the affected person with appropriate support?
  • What type of support would be helpful?

  • Follow-up and communication

  • May CRRIC contact you for additional information?
  • Are you comfortable with relevant information being shared with a trained investigator or safeguarding professional on a need-to-know basis?

  • Additional information

  • Acknowledgement*
  • Should be Empty: