Anonymous Incident Report Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Help us, help you! Report any incident you witnessed or were involved in during any of our events using this anonymous form. If you felt harassed, discriminated against, or hurt in some way, please fill out this form to provide us details to help prevent any similar incidents from happening in the future.

Note: Your entry will remain anonymous, unless otherwise given permission. Your entry is strictly confidential and any personal information provided will only be used to help us follow up with you if requested.

Reference to our Code of Conduct and Community Guidelines: https://bit.ly/BergenWestiesCodeOfConduct

Type of Incident *

Unwelcoming Behavior

Harassment

Discrimination

Accidental Injury

Security/Safety

Illegal/Criminal

Other:

Relation to the Incident *

I witnessed the incident.

I experienced or was otherwise involved with the incident.

When did the incident occur? *

YYYY

Incident Details *

Please provide a narrative description of the incident, including location of the incident, the sequence of events, and results of the incident. If known, please include names of other witnesses or other individuals who were involved in the incident. Names will not be disclosed without your permission unless there is an immediate danger.

Would you like for us to contact you to follow up? If so, please leave your email or phone number below.

Anything else you'd like to let us know?

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms