Freedom Project: Impact Form
This feedback form is for Freedom Project volunteers, staff, participants, and community members to report Concerning Incidents -- Incidents which have a harmful impact or potential harmful impact to Freedom Project participants, staff, volunteers, or the community pertaining to issues such as safe spaces, personal well-being, morale, effectiveness to fulfill Freedom Project mission/vision/values, commitment to racial equity & social justice, facility/ property, legal liabilities, and/or public image. Form may be completed directly by concerned person or verbally reported to an Office Staff member who will transcribe the incident on this form at the time of report.

NOTE: If the Concerning Incident requires emergency attention, report to Executive Director immediately. All other feedback is to be reported at the next Office Staff Meeting.

Email address *
(Optional) Name of Person Giving Feedback:
Your answer
Date(s) of the incident:
Your answer
Relevant Person(s):
Your answer
Is this the first time you reported this incident?
(a) If this incident has been reported previously, please indicate date of report:
MM
/
DD
/
YYYY
(b) If you have given this feedback but not in a report, which Office Staff did you tell? And when?
Your answer
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