HighEdWeb Safety Incident Report Form
Your report will be kept confidential, and only shared with HighEdWeb staff who are addressing your report. Responses will not be shared without your express permission. If you are uncomfortable making a report to the staff, please contact to executive director at highedweb@highedweb.org.
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What happened? *
When did this occur?
Where did this occur?
Who was involved?
Your name
(Optional: provide only if you feel comfortable)
What method should we use to follow up with you?
(Optional: provide only if you feel comfortable. Examples include email address or phone number and whether a text or call is preferred.)
Would you like to designate a specific Safety or Conference Committee representative to follow up with you?
(Optional: provide only if you'd like a follow-up, and if you'd like that to be from a particular person.)
Is there anything you'd like to tell or ask us?
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