St. Louis DSA Misconduct Reporting Form
The St. Louis chapter of the DSA promotes safe and ethical spaces where members can be comfortable and free from harassment.

Please answer the following questions as accurately and thoroughly as possible so that we can address your concerns most efficiently and effectively. Within 7 days of the completion of this form the accused person(s) will be notified. When the Comrades-at-Large are able to recommend an action to the Executive Committee, the reporting individual(s) and the accused individual(s) will notified beforehand. The investigation will be completed within 30 days of the submission of this form.

Comrades-at-Large will process these reports with the utmost care for confidentiality. However, they may need to provide the Executive Committee with sufficient information about the complaint to support any recommended resolution or disciplinary action. In the case that we should contact witnesses about this report, we will only convey necessary information in order to obtain relevant evidence. Furthermore, in any recommendation presented to the Executive Committee, only information pertinent to the decision will be shared.

The following links might be helpful in understanding this reporting process:
- The national DSA Harassment Policy:
- The St. Louis DSA code of conduct:
- Article XII of the St. Louis DSA Bylaws, which discuss disciplinary actions:

Email address *
Which Comrade at Large would you like to process this report? *
Please understand that you can choose one Comrade-at-Large to follow up with you and conduct any investigation. However, in the case that recommendations need to be conveyed to the Executive Committee, the other Comrade-at-Large will be made aware of the situation. The Comrades-at-Large would prefer to work together whenever possible.
Name(s) and preferred pronouns of person(s) reporting: *
Your answer
Best form of contact (email and/or phone number): *
Your answer
When did this incident occur? (Please provide a date and time or range of dates and times): *
Your answer
Name(s) of person(s) whose actions are being reported: *
Your answer
Any contact information for person(s) whose actions are being reported (as applicable):
Your answer
Please provide a brief but detailed description of the incident. *
Your answer
Were there witnesses to this incident? *
If yes, please name:
Your answer
Please list any other individuals who might be able to provide further information regarding this incident:
Your answer
Please indicate what type of resolution or disciplinary actions you think may be appropriate: *
**denotes an option which must be voted on by the local chapter membership and cannot be administered solely by the Comrades at Large and the Executive Committee**
If not covered above, briefly describe the type of response you hope to see from the Comrades-at-Large in relation to this report.
Your answer
Can this report be sent in its entirety to the person(s) you are reporting? *
Please be advised that within 7 days of the completion of this form the accused person(s) will be notified.
If no, how would you prefer this report be conveyed to the person(s) reported?
Your answer
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