Anonymous Report Form
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Step
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Incident Details
Date of Incident(s)
*
If Multiple Please Specify the Dates Below:
Please let us know the date that the incident happened and the date that it carried on to.
Location of Incident
*
Time of Incident (optional)
Nature of the Incident (tick all that apply)
*
Unwanted touching or physical contact
Inappropriate comments or jokes
Sexual gestures or exposure
Repeated unwelcome advances
Sharing explicit content
Use of authority to pressure someone
Other (please specify)
Please let us know
*
Detailed Description of the Incident
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(select that the
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People Involved
Person(s) the Complaint Is About
*
Any Witnesses?
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Yes
No
Please provide names or descriptions
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Next
Impact on You (optional)
How has this incident affected you?
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Previous Reporting
Have you reported this incident to anyone else?
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Yes
No
Who and When?
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Next
Preferred Action (optional)
What would you like the company to do? (select one or more)
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Investigate quietly
Issue a warning
Provide training
Just record it for now
Not sure
Other:
Please Specify
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Next
Follow-Up Permission
Do you consent to a confidential follow-up (non-anonymous)?
*
Yes – I will provide my contact details below
No – I prefer to remain anonymous
Name
*
Phone Number
*
Email
*
Email
Confirm Email
Submit
