Incident Report Form
This form collects information on incidents of sexual assault, sexual harassment, discriminatory harassment, or stalking related to the ICAPS conference. This includes in-person or virtual ICAPS events, events during ICAPS dates at or near an ICAPS venue (e.g., dinner after sessions end), and ICAPS reviewing cycles. If the incident(s) you wish to report occurred outside of these situations, including during research activities intended for eventual ICAPS publication, you must consult with the appropriate institution for the proper reporting mechanism. Data compiled from this form are used to inform the ICAPS Executive Council and ICAPS Community about the ICAPS climate; we will make our best efforts to maintain anonymity in all reports.
Please see the current ICAPS Code of Conduct at
. Incidents of concern not in violation of the Code of Conduct should still be reported.
If you would like to report privately or speak privately about an incident during the conference, please contact the current ICAPS 2020 Advocates, Eva Onaindia (
) and Jendrik Seipp (
), either by email or other means. Incidents reported only to ICAPS Advocates may not end up reported to the ICAPS Inclusion Chair or ICAPS Executive Council.
The information reported using this form is accessible to the ICAPS Inclusion Chair (currently J. Benton, NASA). Others may obtain access to this information under the following circumstances:
* There is an apparent ongoing risk to personal safety requiring intervention by local authorities
* Law enforcement officials request this information
* Local laws have been violated that require a report to authorities
* Legal concerns arise which require consultation or reporting to other individuals (e.g., legal professionals, participants in legal proceedings)
* You wish a follow-up with an ICAPS Advocate (they will be given data from the submitted report)
The ICAPS Inclusion Chair will otherwise do all in their power to maintain your privacy.
You will have the opportunity to add contact information if you wish a follow-up from the ICAPS Inclusion Chair or an ICAPS Advocate. If you do not provide this information, we cannot follow-up. You must report incidents directly to the ICAPS Inclusion Chair or an ICAPS Advocate before any actions regarding an incident can occur.
You cannot edit this form after submitting.
Affiliation with the incident:
I am a victim/survivor of the incident
I am a third party (e.g., friend, supervisor/advisor, colleague, witness)
Type of incident(s) (check all that apply):
These may apply to either online or in-person incidents.
Non-Consensual Sexual Contact
Non-Consensual Sexual Intercourse or Rape
Relationship Abuse (reviewer/author, ICAPS mentor/student, or similar relationship)
Discriminatory Harassment (e.g., denigrating an individual based on personal characteristics)
Stalking (including Cyberstalking)
Online Impersonation for the Purpose of Harassment
Have you made any previous reports about this incident to an ICAPS Advocate or the ICAPS Inclusion Chair?
No, but I have previously reported this incident to another place
The following questions ask about the incident(s). Please leave answers blank if you do not know, prefer not to answer, or the question does not apply to the incident. We understand that the victim/survivor and perpetrator information may involve allegations (e.g., if you are reporting as an non-witness, external third-party). Please answer to the best of your ability. You will have an opportunity to explain at the end of this form.
Date of incident(s):
Include day, month, and year, if known. Write full date in English or use DD/MM/YYYY format.
Approximate time of incident (if you are reporting more than one incident, explain in description):
Enter time, if known.
Victim/Survivor's gender (inclusive of whether the victim/survivor is non-binary; if multiple victims/survivors, indicate in the incident description below):
Is there ongoing abuse or harassment?
Unsure/Unknown/Not Applicable/Will Explain
Is the victim/survivor a student?
Unsure/Unknown/Not Applicable/Will Explain (e.g., multiple victims)
Perpetrator's gender (inclusive of whether the perpetrator is non-binary; if multiple perpetrators, indicate in the incident description below):
Is the perpetrator a student?
Unsure/Unknown/Not Applicable/Will Explain (e.g., multiple perpetrators)
Did the incident(s) occur during a review cycle?
If the incident(s) occurred in person, please give the event and location:
Please briefly describe the incident(s) to the best of your ability.
Would you like someone to contact you regarding this incident? (required)
If you would like someone to contact you, you must also give your information below. Do not give any one else's name and email address. If you choose to have an ICAPS Conference Advocate contact you, they will be informed of this incident information by the ICAPS Inclusion Chair.
Yes, the ICAPS Inclusion Chair
Yes, an ICAPS Conference Advocate
Please only give the name of the person filling out this form.
Your Email Address
Please add any suggestions about this report form that might be helpful
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