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Incident Report
Please use this form to report any violation of our Safe Space Statement.
This report will be kept confidential and discussed only at our executive board level. All investigation and actions taken will be documented.
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Email
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Your email
Your name:
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Your answer
Contact number:
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Your answer
Contact email:
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Your answer
MiA Event/Program where incident took place:
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Your answer
Description of offense (include who, what, where, when)
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Your answer
Name of Alleged Harasser:
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Your answer
Witnesses to incident:
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Your answer
Other important details:
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Your answer
Do you understand that MiA will investigate this matter and take appropriate action?
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Yes
No
Do you want to be informed of the actions taken after the investigation?
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Yes
No
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