MHB Reporting Form
This form can be used as a "suggestion box", a place to ask questions, or a way to report an incident during or outside event hours. It will be monitored regularly by the safety and access team. You are welcome to use the form anonymously, or with your name, although there are limits to the interventions we can make if we do not have a way to follow up with you. The first page of this form asks for basic information, and the second page asks for more optional detail about what happened and how we can follow up with you.

About this form:

1) This form does not automatically collect emails or other contact information.

2) You may request that we contact you. This is done by voluntarily including contact information. It is okay to submit a form anonymously if that is more comfortable for you. All reports submitted using this form will remain confidential within the safety and access team unless our policy dictates the need to share certain kinds of information. If you have specific concerns about who this is shared with and how, please use the: " If you'd like someone specific to read this..." question to tell us more. We will do what we can, within our policy and personal resources, to make that happen.

3) If you need support filling out this form, please ask the on-call member of the safety and access team. A volunteer can help you find us!

4) In the case of a medical emergency on site, please call 911 if necessary before informing the safety and access team.

5) If you have an event-related emergency after-hours, Jaesic can be reached at 585-747-7760. For all other needs, please use the report form - we check it regularly and will respond as soon as possible.


[This form was created (directly or indirectly in inspiration) by Jaesic Wade, Fen Kennedy, Indigo Dawn and Sarah Taub, and Riley Burke Crozier.]

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Today's date *
MM
/
DD
/
YYYY
Time right now as you make the report: *
Time
:
Do you feel like your safety is immediately at risk?
*
If you'd like someone specific to read this (a woman, a POC, a specific organizer etc.) please indicate below. We will endeavor to meet these requests within the limits of our team. Certain information may need to be shared with other team members in order to act on your report effectively.
Name (optional):
Pronouns (optional):
I have a general comment, suggestion, or question:
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