Q1. Tell us what happened: what have you experienced or know about?
Every concern is different. The more information you tell us, the more we can understand what has happened. Whatever it is, let us know.
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Q2. Tell us who or what the incident or wellbeing concern is about. – Select all that apply
Every concern is different. The more information you tell us, the more we can understand what has happened. Whatever it is, let us know.
Free text box
Q2. Tell us who or what the incident or wellbeing concern is about. – Select all that apply
- Me
- Someone else
- Something else
Q3. Select one of more categories that best describes the incident or concern. – Select all that apply
- A wellbeing concern
- Harassment
- Sexual misconduct / harassment / assault
- Bullying
- Discrimination
- Hate incident or crime
- Other
- I'm not sure
Q4. Tell us about your relationship to the Academy
This helps us to direct your concern to the right department within the Academy.
I am a:
Junior Academy
This helps us to direct your concern to the right department within the Academy.
I am a:
Junior Academy
- Student
- Parent or guardian of student
- Staff member
- Visitor
Senior Academy
- Undergraduate student
- Postgraduate student
- Staff member
- Visitor
Other
- Visitor
- Other
- Prefer not to say
Q5. Tell us the details of the person you are concerned about
Their name is:
They are a:
Junior Academy
Their name is:
They are a:
Junior Academy
- Student
- Parent or guardian of student
- Staff member
- Visitor
Senior Academy
- Undergraduate student
- Postgraduate student
- Staff member
- Visitor
Other
- Visitor
- Other
- Prefer not to say
Q6. Is the person named above aware that you are making this report?
- Yes
- No
Q7. Contact details if known
- Phone
- Other
Q8. Tell us about any factors that you think may have contributed to the incident or wellbeing concern you are reporting. – Select all that apply (optional)
- Age
- Trans or non-binary identity
- Having caring responsibilities
- Disability or impairment
- Ethnicity, race, nationality
- Gender identity
- Having children or pregnancy
- Religion/belief
- Sexual identity
- Other
Q9. Why have you chosen to report anonymously today? – Select all that apply (optional)
- I've told someone in the past and nothing happened
- I'm worried I won't be believed
- I feel embarrassed/ashamed
- I'm worried about the repercussion for me or others
- I don't want to get anyone in trouble
- I'm worried about being called a trouble maker
- I’m concerned it might impact my studies or future career
- I've told someone before but it wasn't taken seriously
- I don’t think it’s that serious
- The person didn't want to tell you themselves
- I don't know what to do
- I don't want anyone to know what happened
- I feel like they have more authority than me
- Other
Q6. Belonging
We encourage you to complete the following equality monitoring data so we can understand what is happening within our community. This will also help us to identify trends and inform our diversity activities. (Optional)
- How old are you?
- I identify as a
- What sexuality do you identify as?
- What is your ethnic group?
- What faith/religious family do you belong to or identify with?
- Do you have an impairment, health condition or learning difference that has a substantial or long term impact on your ability to carry out day to day activities?
Review and submit form.