HCT Issue Resolution Form

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In order to support our Mission Statement we need to ensure we maintain a safe and accepting culture.

This form is anonymous unless you decide to identify yourself in your responses.

Please use this form to notify the Board of Directors of any issues you would like looked into.

Common uses include but are not limited to Facilities Issues, Safety Issues, Incident Reporting, etc.

We encourage everyone to work directly with each other to resolve conflicts and escalate to someone such as a Director or Producer if needed. If you do not feel progress is being made please use this form to file a complaint.

What is the issue you want to report?

Describe the issue as specifically as possible.

When and how did you become aware of the issue?

How long has the issue existed?

When was the most recent occurrence of this issue?

Can you identify any documents, persons, or activities that we can use to verify the issue?

Is there any additional information that might be useful to us in evaluating this issue?

May we contact you? *

If you respond yes, you will need to inform us of who you are which will make this not anonymous.

Yes

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