BCLA Code of Conduct Incident Report

For use by a member of the CoC Committee when contacted about a potential harassment that is not a violent or criminal incident.

Date of report
DD slash MM slash YYYY
Time of report:

: Hours

Minutes

AM/PM
CoC Committee member’s name:
Name and contact details of the person reporting the incident:
Name and contact details of the person alleged to be violating the Code of Conduct:
Reason for the Complaint:
Specific details:
Date of incident
DD slash MM slash YYYY
Time of incident:

: Hours

Minutes

AM/PM
Location/session of the incident:
Witnesses names, if applicable:
Response from the alleged violator:
Additional pertinent information:
CoC Committee member’s comments:
Next people contacted by the CoC member taking the report, including date and time.
Sanction decided upon (by who and on what date):
Date violator was contacted about the sanction:
DD slash MM slash YYYY
Time that the violator was contacted about the sanction:

: Hours

Minutes

AM/PM