Binary Shift - Incident Report Form

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If you wish to report an incident of harassment occurring during the Binary Shift Conference 2018, please fill in the form below. If you wish to be consulted/contacted regarding your report, please include your name and contact details; but you can also remain anonymous if you wish. Please answer questions as specifically as possible.

What time did this incident occur? (Approximate time or a time window is also helpful) *

Where did this incident occur? (Main hall, outside, exhibition space, online...?) *

Please describe the incident that occurred and the people involved. (If you don't know their names, please describe the people involved with as much detail as possible): *

Were there other people in the area at the time who witnessed the incident? Please include their name and/or a description of them: *

If you wish to be contacted regarding your report, please include your name and contact details of choice:

Thank you for reporting this incident. Please remember that you can talk in person to any of the Binary Shift organisers (identifiable by their Binary Shift shirts and lanyards) for support, or email jaklene@gipps.tech for assistance during or after the conference.

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