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Safety Check for UPLB Students
Please share with us incidents you witnessed firsthand inside the campus that you felt merit reporting to our Safety and Security Office (SSO) for their appropriate action.
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* Indicates required question
Email
*
Your email
Name
*
Your answer
Mobile number
*
Your answer
College
*
Choose
CAFS
CAS
CDC
CEAT
CEM
CFNR
CHE
CVM
SESAM
CPAf
Incident to Report
*
Voyeurism
Groping
Stalking
Catcalling
Physical violence
Verbal abuse
Other:
Required
Brief description of incident (indicate what happened, where, and the exact time if possible)
*
Your answer
Have you reported the case to SSO?
*
YES
NO
If the answer to the previous answer is YES, has the issue been resolved?
YES
NO
Clear selection
Can OVCSA contact you further to assist in bringing this issue up to SSO?
*
YES
NO
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