Code of Conduct Incident Report

We are committed to providing a safe and welcoming environment for all MICCAI Society event attendees. If you have experienced or witnessed any behaviour that you believe violates our Code of Conduct Policy, please use this form to report the incident. We take all reports seriously and will take appropriate action to address them.

The MICCAI Code of Conduct Policy can be found here: http://www.miccai.org/about-miccai/code-of-conduct-policy

Note: Your privacy is important to us. You have the choice to remain anonymous. If you provide your name and contact information, it will be kept confidential and only used by the MICCAI Code of Conduct Officers (conductofficers@miccai.org) to follow up on this report.

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Your Information
Note: Without your personal information, we may be limited in our ability to pursue a full investigation.
Your Full Name:
Email Address
Phone Number:
Details of the Incident
Description (optional)
Date and Time of the Incident
Please provide as accurate a time as possible
 *
MM
/
DD
/
YYYY
Location of incident
eg. email, workshop room A, vendor booth, etc.
 *
Description of the incident
Please provide as much detail as possible. Describe the behaviour or situation you are reporting. Include any relevant conversations, actions and/or reactions.
 *
Involved Parties
Please list names, roles or any identifiers of the individuals involved, including witnesses, if known. Otherwise, put N/A.
 *
Follow-up
Note: We cannot follow-up with you without your personal information included above.
 *
Additional Information
Description (optional)
If you have any photos, videos, emails or other evidence related to the incident, please mention them here.

Note: Do not include sensitive content directly in this form. The MICCA Code of Conduct Officers will reach out to you for any detailed evidence if necessary.
Is there anything else you'd like to share about the incident or your experience?
Thank you for helping us maintain a respectful and safe environment for everyone.

For immediate safety concerns, please contact local police or security services.
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