For reporting incidents of violation or inappropriate behavior
This section is for a person filling in this form on another person's behalf.
Name of person filling in form for another person (optional)
Phone number of person filling in form for another person (optional)
Email address of person filling in form for another person (optional - This form content will not be sent to this email address.)
The rest of the form is about the person with the complaint, regardless of who fills it out.
Your Name (name of person with the complaint) (Optional)
Phone number (optional)
Your private email (not work or shared)
What happened, and with whom?
When and where did it happen?
Who else was present when this occurred? If you don't know their names, or if you wish to keep their identities confidential, please state so here.
What steps, if any, have already been taken in this incident?
What would you like from HAI in response to the incident?
Just for HAI to be aware of this
Please contact me to discuss
Please contact the other person(s) to discuss
Support in talking with the other person(s)
What HAI Region did it occur in?
Canada - Ontario
US - East Coast
US - Midwest
US - Northern California
US - Southern California
Is there anything else you'd like us to know?
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