Code of Conduct Incident Report
Use this report to document a code-of-conduct concern with clear details about what happened, when and where it occurred, who was involved, any witnesses or evidence, and what follow-up is needed.
Reporter Information
Reporter name
*
First Name
Middle Name
Last Name
Role or relationship to the incident
*
Please Select
Employee
Student
Visitor
Manager
Other
Email address
*
example@example.com
Phone number
Please enter a valid phone number.
Format: (000) 000-0000.
Incident Details
Date of Incident
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Time of Incident
Hour Minutes
AM
PM
AM/PM Option
Location
*
Short Incident Summary
*
Detailed Description
*
Type of Code-of-Conduct Issue
*
Harassment
Bullying
Discrimination
Unsafe Behavior
Inappropriate Language
Property Misuse
Confidentiality Breach
Other
People Involved (Names or Identifiers)
Impact, Witnesses, and Evidence
Were there any witnesses?
*
Yes
No
Not sure
Witness details
Evidence available
Photo
Video
Message
Email
Document
Other
Immediate impact, harm, or requested follow-up action
Submit report
Should be Empty: