ZOUK UNITY: Incident Reporting Form
Use this form to report consent incidents (including boundary-crossings, inappropriate behavior, harassment or violations of the Zouk Unity's Consent Code of Conduct) that you have experienced or witnessed, at events and beyond. No incident is too big or too small. Reporting builds awareness, strengthens our community and empowers others to do the same. All of your answers will be held strictly confidential to Zouk Unity Team (Heidi Anastasia, Sunny Wo, Sara Lim, Jeff Zhou) unless you give permission otherwise.
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Where the incident(s) took place *
When the Incident took place (if you are unsure of the exact date, please provide an approximate date) *
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When and where did this incident take place? Please share the specific time and location (e.g. The room location at x Studio or equivalent if outside of Zouk Unity Events / Classes). *
Who was involved? (i.e. the boundary crosser and/or the person whose boundary was crossed (if not you)). If you don't know their name(s), or if you wish to keep their identity confidential, please state so here. Alternatively, if you would like us to follow up with them, please give their name(s) if you know, or if not please provide any identifying characteristics you can remember (e.g. physical features, clothing, jewelry) and any contact information you have for them (e.g. social media).
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What happened? Please be as specific as you can and share a detailed description of the incident(s) in your own words. (e.g. What was the context of the incident,  what was the behavior of the other person that was  inappropriate, suspect, or otherwise not in line with our Consent Code of Conduct).
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Was a verbal 'No' or 'Stop' or any other verbal indications of your personal boundaries clearly expressed to the boundary crosser? If so, could you describe what you communicated verbally, and what was the reaction from the boundary crosser?
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If you expressed your boundaries verbally and answered the question above, you may skip this question. If you did not express your boundaries verbally, can you describe how you expressed your boundaries non-verbally?
Did anyone else witness this incident or behavior? If so, and if you are open to sharing -- who? We welcome names or other identifying information. Be assured that we will not engage with any witnesses you provide without your consent. 
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Have you, or do you intend to, follow up with the person(s) involved on your own?*
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Do you feel unsafe around the person(s) involved in the incident(s)?
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What sort of response would you like?*
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Required
Your full name (mandatory) and the best way to contact you (e.g. provide your mobile number or email or Facebook name). Note that you may elect to remain anonymous (next question) but you are required to provide your name as part of the lodging of this incident record.
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Do you want to remain anonymous?* By ticking Yes, Zouk Unity Team will not share your name or any identifying features of this complaint with anyone without your prior permission. By ticking No, you give permission for Zouk Unity Team to share your name with the boundary crosser as appropriate.
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Is there anything else you would like to add?
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