Incident Report Form

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Thank you for choosing to make a report. The NSCL Ethics Committee is committed to reviewing and investigating all incident reports to create and maintain a safe environment for all members. The committee chair will be immediately notified that a report has been submitted. All reports are maintained confidentially and information is not discussed outside the committee, unless required by law or necessitated by NSCL or NJCL convention rules. After reviewing your report, a committee member may reach out to you for further information.

Note: Please understand that while anonymous reports are accepted and encouraged, they may limit what actions are available to the committee. Information is not shared beyond the committee, unless express permission is obtained, or required by law.

Can we contact you for more information?

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Your Contact Information

Please describe the incident. Use as much detail as you can that you feel comfortable with giving. Any names or dates that you can include will aid in an investigation (e.g. names, dates, locations). Please indicate if you have additional documentation.

What kind of action(s) would you (or the person on whose behalf you are reporting) like to see taken?

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