Emergence Incident Report Form
To file a report with the Emergence Conduct Committee, please fill out and submit this Incident Form. This form collects information regarding possible Code of Conduct violations. The completed form should contain sufficient detail for the Committee to evaluate the allegations, including communicating with the accused and any witnesses.
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Email *
Today's date *
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Name
Report anonymously *only* if you do not wish to have any follow up. Anonymous information can be useful when it contains verifiable facts but information with no contact information is, by its nature, of limited value in our process.
Please enter preferred contact details below *
What is the nature of the violation that you wish to report? *
Name of the person(s) you are reporting? *
Include or indicate any known alias
How is the person connected to the Emergence community? *
For example, has the person attended  Emergence events and/or related burner events?
Please note the date and time, if possible, when the incident took place. *
 If you're reporting several instances, please enter a time range and note any specific instances in the narrative.
Where did the incident(s) take place? *
Were bystanders present when the incident(s) occurred? *
If yes, please specify if you are acquainted with them should the investigators need to reach out to them with your approval. Include emails if possible and appropriate. We will not contact anyone without discussing the case with you first.
Basis of Complaint *
Please describe the incident(s)
What is your desired outcome of this process? *
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