ReidAboutSex Anonymous Incident Reporting Form

Request edit access

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Thank you for visiting ReidAboutSex/Reid Mihalko's anonymous reporting form. If you feel that your consent has been violated or ignored at a Reid Mihalko event or online program (by Reid, his co-facilitators or helpers, or by an attendee), we have created this form for you.

This form is anonymous by design and by default. We do not require you to share your name or contact info. Unless you tell us otherwise, the information you share will be kept confidential and used only for us to improve the safety and quality of our events. Because this form is anonymous, if you wish Reid to respond, please indicate in the appropriate fields below and Reid will respond within 72 hours in most cases. Information from this form goes directly to Reid's inbox. If you would like to report a consent violation by Reid and do not want Reid to see it, anonymous reports about Reid may be made to Reid's Accountability Pod at [email protected]Â - Learn more about Reid's Pod at http://TinyURL.com/reidaccountability.

CONSENT INCIDENT REPORTING SECTION

If you feel that your consent was violated or ignored (or you are acting on behalf of someone who's consent was violated or ignored), please fill out the following questions to the best of your abilities. Thank you in advance.

What happened?

Please provide a description of the behavior you want to bring to our attention as well as who was involved.

When and where did it happen?

Please let us know the date, time, and location as specifically as you can.

Is there anyone else you'd like to make us aware of who may have experienced this as well, or who was a witness to the experience?*

*Before sharing people's names, please make sure you have their permission to do so. Thank you.

Have you yourself followed up, or intend to follow up, with the person(s) involved?

Yes

Undecided

Other:

Clear selection

What sort of response would you like from Reid?

I want a mediation or clearing conversation with the person(s).

I want you to look into this on my behalf and follow up with the involved parties.

I want to talk with you, but don't necessarily need you to talk with the person(s).

I just want you to know about this incident, no follow up is needed.

Other:

Would you like Reid to contact you (or someone you've appointed) about your report?

This form, by default, is anonymous. We do not require your name and info. However, this also means we have no way of contacting you back. If you would like us to contact you or someone you've appointed to be your contact person, please let us know how in the field below. If you do not want us to contact you, simply type No or leave the field blank. Thank you.

Additional contact preferences:

If you are a yes above to receiving a response, please indicate an appropriate way we can reach out...

I do not want to be contacted directly. The information above is for a 3rd party who has agreed to talk to you on my behalf.

You have my permission to contact me directly through the info above.

I would like to be contacted by a 3rd party of your choosing. I do not want to be contacted directly by you.

Other:

Thank you for taking the time to inform us by submitting this form. We deeply appreciate it.

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms