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. (If you have anything you would like to submit like screenshots or images, please keep it safe and discuss this with the advisor).
Free text box
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. (If you have anything you would like to submit like screenshots or images, please keep it safe and discuss this with the advisor).
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 your details so we can contact you to discuss the concern and offer you support
If you are contacting us about someone else, we’ll also ask you to provide their details on the next page. However, if you don’t want to provide your details, you can always tell us anonymously (the form will be copied across).
My name is:
If you are contacting us about someone else, we’ll also ask you to provide their details on the next page. However, if you don’t want to provide your details, you can always tell us anonymously (the form will be copied across).
My name is:
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
I would like to be contacted by:
- Phone
- Other
I confirm that the Academy can contact me using these contact details:
- Yes
- No
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
Q10. 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?