SPEAK UP Form - record an incident of harassment, bullying, discrimination or violence
The University of Portsmouth is committed to fostering an inclusive culture where everyone is treated with dignity and respect. We want to know about any incident or situation that falls short of this aim, so we can offer appropriate support and/or take action to improve.

As a University of Portsmouth student you can use this pilot form to tell us anonymously about:
- your own experience
- something you have witnessed
- something you have been told about by the person who experienced it

You can choose to remain completely anonymous. However, you will be able to provide contact details at the end if you would like to talk to someone confidentially for support or for advice about further action, where relevant.

University of Portsmouth staff should use the form to record all relevant issues affecting or carried out by a University of Portsmouth student, either witnessed by or reported to the staff member. With the student's consent their details can be provided in order to ensure they receive appropriate support and advice.

This form is NOT a formal report and will not on its own result in any action being taken or any formal record being made.

The form is monitored by staff from the Equality & Diversity Office and the Student Wellbeing Service, who operate strict confidentiality. Regular oversight of the form is maintained by the confidential University Safeguarding Cases Panel.

Please record only one incident/situation per form. If you know about more than one separate situation or incident (eg. bullying or harassment by someone different, or happening to someone else), please submit another form.

Consent
This pilot form is part of a wider project to strengthen a zero-tolerance culture towards bullying, harassment, discrimination and violence at the University of Portsmouth. By using this form you are consenting to your data being included - strictly anonymously and without any identifying details - in monitoring, reports and publications aimed at evaluating the project and improving safeguarding at the University.
I understand and consent to the terms of use for this form *
Required
I am *
Next
Never submit passwords through Google Forms.
This form was created inside of University of Portsmouth Staff. Report Abuse - Terms of Service