Member Incident Report
Member you are making complaint about:
Date of Incident:
Type of incident
Please check all that apply!
Boundary crossing related to touch or any type of sexual contact
Boundary crossing related to communication
Trolling-communication with an unknown party that continues after boundaries are articulated
Continued verbal communication once boundaries have been articulated
Continued electronic communication once boundaries have been articulated
Confidentiality violation (they shared information about you or outed you or a fellow member)
Use of abusive, harassing or demeaning language about you or other members
Intoxication or drug use
Leveling system violations
What role do you want MCCC to play?
I can handle this myself, this is just an FYI for MCCC to be aware of this incident
I don't need any support for myself, but I think MCCC needs to take action regarding this incident
I need support in handling this incident
In case of a boundary violation (if inapplicable, skip to the next section):
How were your boundaries crossed?
Did you feel physically unsafe?
Did you feel emotionally unsafe?
Did you know your boundaries before they were crossed?
(many people only figure this out afterwards)
Did you clearly articulate your boundaries before and/or after they were crossed?
Were you able to let the person know what they did (direct communication)?
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