Code of Conduct – Incident Reporting Form

Incident Reporting form

Do you wish to keep your name confidential?

speaker, committee Were

Name

First

Last

I am reporting

Date of incident:

Date

Time

Time (approximate)

Location (e.g. session, field trip, social event, online):

Please describe what happened, including any relevant context.

You may include details of harassment, bullying, discrimination, intimidation, or other inappropriate behaviour.

Name(s) of person(s) involved (if known):

First

Last

Role(s) (e.g. delegate, speaker, organiser, exhibitor):

Were there any witnesses?

If yes, please list names or descriptions (if known):

If you are able to provide evidence of the violation, please attach it here

Drag & Drop Files, Choose Files to Upload

Do you consent to this information being shared with the WSC4 organising committee if necessary to address the issue?

Do you consent to WSU contacting you to follow up on this report?

Phone

By submitting this form, you acknowledge that the information provided is accurate to the best of your knowledge.