POrtalBurn Incident Report Form
To file a report with the POrtalBurn Code of Conduct Committee, please fill out and submit this Incident Report Form. This form collects information regarding possible Code of Conduct violations. The completed form should contain sufficient detail for the investigators to begin an investigation. Conduct Committee Leads receive this form first, and then they will review the report with you before assigning your case to a team investigators.
Reporter's (Your) Name *
Report anonymously *only* if you do not wish to have any follow up. Anonymous information can be useful when it contains verifiable facts but information with no contact information is, by its nature, of limited value in our process.
Your answer
Please enter preferred contact details below *
eg: phone number, email address, etc.
Your answer
What is the nature of the violation that you wish to report? *
Please check all that apply.
Required
Can you identify those involved in the incident? *
Name of the person(s) you are reporting? *
N/A if unknown
Your answer
Please note the date and time if possible when the incident took place. *
If several instances please enter a time range and call out any specific instances in the narrative.
Your answer
Where did the incident or incidents take place? *
Your answer
Were bystanders present when the incident(s) occurred? *
If yes, please specify if you are acquainted with them should the investigators need to reach out to them with your approval.
Your answer
Basis of Complaint *
Please describe the incident(s)
Your answer
Please note: The POrtalBurn Code of Conduct Committee is comprised of volunteers. While we aim to reply to conduct complaints in a timely manner, we cannot promise to respond immediately. *
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