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WisCon safety incident report form
This form is confidential and will only be viewed by the WisCon Safety leads and Anti-Abuse lead(s). Responses will not be shared without your express permission. If you are uncomfortable making a report to the Safety or Anti-Abuse leads directly, please contact anyone on the Conference Committee with whom you feel comfortable.
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* Indicates required question
What happened?
*
Your answer
When did this occur?
Your answer
Where did this occur?
Your answer
Who was involved?
Your answer
Your name:
(Optional: provide only if you feel comfortable.)
Your answer
What method should Safety use to follow up with you, if any?
(Optional: provide only if you feel comfortable. Examples include email address or phone number and whether text or call is preferred.)
Your answer
Would you like to designate a specific Safety or Conference Committee representative to follow up with you?
(Optional: provide only if you'd like a follow-up.)
Your answer
Is there anything you'd like to tell or ask us?
Your answer
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