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ESIP Community Participation Guidelines Incident Report
Please complete this form to report on any potential violation of our Community Participation Guidelines.  We thank you for taking the time to express your concerns. ESIP values its entire community and wants everyone to feel that they have a place where they can raise any concerns (even anonymously) that will be reviewed by management.  We encourage reporting of incidents where someone has engaged in behavior that is potentially illegal or makes you or someone else feel unsafe, unwelcome, or uncomfortable as outlined in these guidelines.  The results of this report, including the reporter's identity, are shared only with ESIP's President, Executive Director and Operations Director and optionally, additional review committee members that may include the Governance Chair and the Vice-President.  If you wish to exclude any of these individuals from your report please send an email directly to  ESIP's President, Executive Director and/or Operations Director to initiate your report.  

Upon submitting your report, you will receive a copy of your responses via email.  


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Email *
Email  (Alias emails are allowed. While you may leave this field blank, it will substantially limit our ability to follow up with you and collect the needed information to successfully resolve the issue)
Are you submitting this report yourself or as proxy for someone else?  *
Please describe the nature of the incident, including a description of the behavior and your account of what happened.  If reporting harassing language, be specific about the words used. *
Provide any identifying information of the individual whose behavior is being reported (e.g. name, nickname, screen name, physical description).
Where did this incident occur? (Be specific: online location, event or physical location) *
When did this incident occur? (Specific date and time if feasible) *
Is the incident ongoing? Is it part of an ongoing pattern of behavior by this individual?
Is this violation likely to put anyone in immediate danger within the next 24 hours? (If the situation is immediately dangerous, contact the on-site security, or call 911 if warranted.) 
 *
Did anyone else observe the incident? If possible, provide names and contact information of anyone else who witnessed or was involved.
Is there any other information you believe we should have about what happened or that you'd like us to know?
Your name (This will not be shared beyond the people listed above without your explicit permission.)
Your phone number (Optional.  This might make it easier for us to follow up with you.)
A copy of your responses will be emailed to the address you provided.
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