Roulette Incident Report Form
Confidentiality Notice
All reports will be handled with sensitivity and respect. Only the designated member of
Roulette’s response team (the HR administrator) will have access to this report unless
further disclosure is required by law or for safety, or with the reporters consent to share.

If there are issues or concerns related to the HR manager, complainant should contact Roulette's Executive Director, Matt Mehlan matt@roulette.org
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