HighEdWeb Safety incident report form
This form is confidential and will only be viewed by the HighEdWeb Safety Committee and HighEdWeb President, as needed. Responses will not be shared without your express permission. If you are uncomfortable making a report to the Safety Committee directly, please contact anyone on the Conference Committee with whom you feel comfortable.
What happened? *
Your answer
When did this occur?
Your answer
Where did this occur?
Your answer
Who was involved?
Your answer
Your name
(Optional: provide only if you feel comfortable)
Your answer
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.)
Your answer
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.)
Your answer
Is there anything you'd like to tell or ask us?
Your answer
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