EWB-USA Incident Reporting Form
This form is to be used to report concerns regarding EWB-USA’s Code of Conduct or other potential policy violations. This information is strictly confidential and will be sent to EWB-USA’s Human Resources representative. The information will be kept in a safe and secure place.

 Fill in as much of the form as possible, leaving fields blank if there is no known information to complete them.
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Full Name of complainant or person filing on behalf of the complainant.
Enter "anonymous" if you are the complainant and wish to remain anonymous.
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Email of complainant or person filing on behalf of the complainant.
Enter "anonymous" if you are the complainant and wish to remain anonymous.
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Phone number of complainant or person filing on behalf of the complainant (optional).

List the people involved in the incident/complaint:
Enter “anonymous” for complainant(s) or individual(s) who wish to remain anonymous.
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Date when incident occurred:

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Location of incident (geographic: country, state, community, etc.)

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Describe the incident/complaint:

Please ensure that the information provided is as unbiased, and factual as possible. Distinguish between what is personally known or observed and what was shared by the person (s) affected by the incident.

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List who else was notified of the incident:

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