On-Set Consent and Boundaries Incident Report Form
Use this form to document consent-related concerns, boundary issues, and incidents on set so the production team can review and follow up appropriately.
Incident Details
Incident Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Incident Time
*
Hour Minutes
AM
PM
AM/PM Option
Production / Project Name
*
Department
Please Select
Production
Direction
Camera
Lighting
Sound
Art Department
Wardrobe
Hair/Makeup
Stunts
Locations
Other
Exact Location on Set
*
Issue / Incident Type
*
Consent Concern
Boundary Concern
Unwanted Interaction
Blocked Communication
Unsafe Instruction
Privacy Issue
Other
Brief Description / What Happened
*
People and Context
Reporter Name
*
Reporter Role or Position
*
Please Select
Actor/Performer
Director
Producer
Camera Crew
Sound Crew
Wardrobe
Makeup/Hair
Production Assistant
Other
Person(s) Involved
*
Who Was Involved?
*
Talent
Crew
Production Staff
Other
Witnesses
Response and Follow-Up
Immediate action taken
*
Stopped activity and separated parties
Paused filming for private check-in
Clarified boundaries and continued
Escalated to supervisor/producer
No immediate action taken
Other
Additional details on immediate action
Were consent or boundary expectations previously discussed or clarified?
*
Please Select
Yes
No
Unsure
What follow-up is requested?
Mediation
Clarification conversation
Schedule change
Supervisor review
Documentation only
Other
Submit Report
Should be Empty: