Beloved Incident Reporting Form
This is the place to report any incidents of inappropriate behavior you experienced at a Beloved Presents event. We believe everyone has the right to a harassment-free time at our events. Your courage in sharing will help strengthen our community and make it a safer place for all.
You will be asked at the end of this form if there is any course of action you prefer we take. We commit to respecting your wishes, unless we feel that an intervention is mandatory to prevent future harm.
All of your answers will be held strictly confidential unless you give explicit consent otherwise.
Sign in to Google
to save your progress.
* Indicates required question
Incident Date & Location
Please provide the name of the event, the date/time, and any specific details about when/where this occurred during the event.
Please tell us what happened and provide a detailed description of the behavior you want to bring to our attention.
Who was the other person(s) involved? If you don't know their name, or if you wish to keep their identity confidential, please state so here.
Intended Follow Up
Have you, or do you intend to, follow up with the person(s) involved on your own?
Level of Urgency
Is this report an emergency? Are any of the involved persons in immediate harm or danger?
What is your desired response from Beloved?
I would like this matter referred to our Healing Justice & Accountability Council for support.
I want you to look into this on my behalf and follow up with the involved person(s).
I want to speak with someone on the Beloved team about this.
I just want you to know about the incident, no follow up response is needed.
You may remain anonymous if you choose.
However, if you would like for us to follow up in any way, please fill out the following details:
Did anyone else witness this behavior? If yes, please provide names with their approval.
Is there anything else you would like to add or let us know?
Thank you for taking the time to make our community stronger and safer for all. While we are operating with extremely limited staff and resources, we will make sure to respond to your incident as soon as possible.
Never submit passwords through Google Forms.
This form was created inside of Beloved Presents.