PATS Safer Spaces Reporting Form

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This form is for reporting any concerns, issues or incidents at Philadelphia Argentine Tango School (PATS) classes or other events.

No action will be taken without your consent.

Please consider including your name and contact information, so that we can follow up with you. You may choose to submit this form anonymously, but it will limit our ability to follow up and to take action based on the information you provide.

All reports submitted using this form are confidential, and only the PATS Safer Spaces Team has access to the information.

Date of Incident (if applicable)

YYYY

Space / Event where the incident occurred

Your Name (optional)

Your Email (optional)

Your Phone Number (optional)

Nature of the Report

I experienced the incident.

I directly observed the incident.

The incident was reported to me.

Other:

Clear selection

Names and/or Descriptions of those involved in the incident.

Please describe the incident in as much detail as possible.

Please describe any actions that have already been taken to address this incident.

We would like to follow up with you regarding this incident. Is it ok if we contact you?

Yes, by phone.

Yes, by email.

Yes, in person.

Other:

Clear selection

Which of the following actions are you comfortable with?

The Safer Spaces Team having a conversation with those involved in the incident to discuss behavior adjustments and ways to address or resolve the incident.

The Safer Spaces Team being present and supporting you while you talk with those involved in the incident.

I would like the Safer Spaces Team to be on the lookout for a recurrence of the problem and be ready to address it in the moment.

I would prefer that no action be taken.

Other:

Thank you for taking the time to make this report, and help make the community safer! If there is anything else you'd like us to know, here's some space!

Thank you to Powerhouse Blues whose reporting form was a model for this one. Learn more about Powerhouse Blues at: https://www.powerhousebluesphilly.com/.

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