Incident Reporting Form

This form allows students to report descriptions of incidents, concerns and involved persons, such as alleged aggressors, harmed individuals and witnesses. Students can also opt to make their reports anonymous. Information provided on this form is submitted directly to the Director. Please provide as much detail as possible in the space below (for example, time and date of occurrence, names, description, place of occurrence, etc.)

Redline takes reports made through this form seriously. Following the submission of the form, the reporting party can expect an outreach of support from our administrative team, if contact information is provided.

Location of alleged incident

Date of alleged incident

YYYY

Name of person who harassed you or someone else

First Name

Last Name

If the alleged harassment was toward another person, identify that other person

First Name

Last Name

List any witnesses who were present

Describe the incident(s) as clearly as possible. Include a full description of the event(s) and verbal statement(s) (i.e. threats, requests, demands, etc.) and what, if any, physical contact was involved

How did you or the person harassed (if not you) react to the harassment?

Name

(optional)

First Name

Last Name

(optional)

Phone

(optional)

(###)

###

####

Incident Reporting Form

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