Firefly Incident Report Form
To file a report with the Firefly Arts Collective 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 investigators to begin an investigation. If the report warrants an investigation, Conduct Committee Admins will review the report with you before assigning your case to a team of two investigators who you will have a chance to approve of.
Your 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.
Your answer
Please enter preferred contact details below *
eg: phone number, email address, etc.
Your answer
What is the nature of the violation that you wish to report? *
Please check all that apply.
Required
Name of the person(s) you are reporting? *
Include or indicate any alias.
Your answer
How is the person connected to the Firefly Community? For example, has the person attended Firefly or Firefly Arts Collective events and/or related burner events such as Decom, Figment, CBC Happy Hour, or other burn events inside or outside the local community? *
Your answer
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.
Your answer
Where did the incident or incidents take place? *
Your answer
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 email addresses if possible and appropriate. We will not contact anyone without discussing the case with you first.
Your answer
Basis of Complaint *
Please describe the incident(s)
Your answer
The Conduct Committee seeks your intention for filing this report. *
Required
Please note: if this form is received during hiatus, it will be received by the Conduct Committee after they reconvene. You will receive an email from the Conduct Committee when they return from hiatus. For urgent issues during hiatus, you may contact the Board directly board@fireflyartscollective.org and inquire about your options. (Please note the board email list is NOT confidential) *
In 2018, Conduct Committee hiatus was from June 19 till July 23.
Required
The Conduct Committee will not pursue legal action, however if you were to do so on your own, all recorded communication received by the Conduct Committee (starting with this report) can be subpoenaed under certain circumstances. *
Please review relevant state laws in this living document https://docs.google.com/document/d/1aDc4SGVbWk7lMVHECKfFznzapvPVboyQ66QRgdEPFzU/pub
Required
This form, once submitted, will be accessible to the Conduct Committee members. Current members are listed below. If you have a strong reason for withholding information from a particular member, please do not use this form, but write directly to the Conduct Committee Admins, Emile Daigle and Sage Kochavi, at conduct-committee@fireflyartscollective.org.
The Conduct Committee members are:

Andi Keeley
Dan Snyder
Darren Torpey
Diana Picariello
Emile Daigle
Sadiya Akasha
Sage Kochavi

If you would like counseling or to speak with a trained crisis volunteer outside of the Conduct Committee, call the BARCC (Boston Area Rape Crisis Center) Hotline at: 800-841-8371.
The hotline is available 24/7 and can help survivors, families and friends, and providers, with referrals to services and understanding additional options available.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms