Jazz Attack Safe Spaces Response Form

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Please report any safe space concerns using the form below. Be aware that no action will be taken based solely on your report without your consent. You have an option to remain anonymous, however please realize that we will not be able to follow-up with you around the incident if contact information is not provided. All reports submitted using this form will remain confidential (based on your request), and only those on the Jazz Attack Safe Space team have access to the information submitted.

Date of Incident (if applicable)

YYYY

Event where incident occurred *

Your Name (optional)

Your email address (optional)

Your phone number (optional)

Nature of the report *

I experienced or directly observed the incident

The incident was reported to me

Other:

Name(s) and/or description(s) 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 love to follow-up with you. Are you OK with us contacting you regarding the incident? *

Yes, by phone

Yes, by email

Yes, in person

Other:

Required

Which of the following actions are you comfortable with? *

The Safe Space team sharing this information with the dance organizers

The Safe Space team having a conversation with those involved in the incident to discuss behavioral adjustments and resolution

The Safe Space team supporting you and being present while you have a conversation with those involved in the incident

I prefer no action to be taken

Other:

Required

We thank you for taking the time to make our community safer! Is there anything else you would like us to know?

Submit

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