Incident Report Form
Please complete this form if you witnessed, experienced or were requested to report conduct that violates our Social Conduct Agreement or Community Leader Agreement. This form is the incident report form named in Firefly's Conflict Resolution and Accountability Policy, and is an important step in our accountabilty and conflict resolution process.

We greatly appreciate your taking the time to fill out this form, as it helps us have a clear picture of incidents and to be aware of patterns which may exist over time. This information helps us understand how we can support the integrity of the Firefly container and community. Even if the incident was resolved, we would still like to know about the incident. If it was resolved, please note accordingly when filling out the form. We do not take action in response to every incident report, actions match the type of conduct (see the Conflict Resolution and Accountability Policy for more information).

This form submits incidents to a private incident log which is reviewed by the Accountability Committee, which is a very small group of board members, staff and volunteers. In instances where a response is needed, a member of the committee will reach out to involved parties as needed. 

Information submitted here is considered confidential. We value the safety and wellbeing of those who may have been harmed, or are reporting conduct, and protect their identities and information as a priority.  Unless it is indicated that information is available to be shared, it will not be shared. Only when necessary, limited information about the person who violated the conduct agreements may be shared in certain contexts within Firefly Gathering or with key decision makers of other gatherings with an expectation of confidentiality. This would only be if there is concern of future harm or issues. In certain instances where a law was broken we may have a responsibility to report an incident to law enforcement.

If you have questions about this form or process, please contact accountability@fireflygathering.org
Sign in to Google to save your progress. Learn more
Are you reporting an incident that happened to/with you OR that you witnessed or heard about from someone else? *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of The Firefly Gathering.

Does this form look suspicious? Report