Incident Report

This Incident Report form is not intended for emergency response. If you are in immediate danger, feel threatened or have suffered an injury, call 911 immediately!
When circumstances permit, Parsec Inc. would appreciate also being notified of the incident.
Email parsec@parsec-sff.org

This form is to submit incidents of harassment, including but not limited to:

• Verbal harassment with sexual overtones or sexual advances.
• Physical misconduct (touching without permission).
• Verbal misconduct; slurs, threats, etc.
• Written misconduct; notes, letters, etc.
• Visual misconduct; body language, gestures, intimidation, etc.
• Sexual or physical assault; unwelcome touching, rape, battery, etc.
• Property damage; destruction, graffiti, arson, etc.
• Discussion(s) entailing sexual themes or hate speech that made you uncomfortable.
• Any other type of verbal, written or physical misconduct that made you feel uncomfortable.

If you feel harassment has occurred during any Parsec Monthly Meeting*, Confluence conference, Parsec Ink function or meeting*, WorD event or meeting*, or any other Parsec function, please fill in the below Incident Report and someone will contact you shortly.

^{*Meetings include in-person and virtual}

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Name *

First

Last

Layout

Email *

Phone

If you would like someone to contact you by phone, please include your phone number.

Please identify your involvement in incident *

• I am the victim
• I am a witness
• Other (Please describe below)

If other, please describe

Date incident took place *

Time incident took place *

Location of Incident *

Please be specific as possible. ie: if the incident took place during a Confluence conference, please include the program or room location.

Name of Alleged Harasser *

First

Last

If unknown, please type “Unknown” in the fields and provide a description of the harasser with your Description of Incident statement.

Description of Incident Statement *

Were there witnesses?

Please list witnesses names if known.

Was this incident reported to anyone in charge of the program at the time it occurred?

First

Last

ie: Chairperson, security, someone in charge of the program.

I agree and understand that by signing the Electronic Signature Acknowledgment that all electronic signatures are the legal equivalent of my manual/handwritten signature. *

• I Agree

Submit

Parsec Inc., is an equal opportunity, nonprofit organization and does not discriminate based upon age, ethnicity, ancestry, gender, gender expression, national origin, disability, race, size, religion, sexual orientation, military status, socioeconomic background, or any other status prohibited by applicable law.