CIEP dignity incident report form (confidential)

Please use this form to guide you in reporting any behaviours defined as unacceptable under Participating with dignity in all CIEP events and activities: The CIEP Dignity Policy that you've witnessed or been subjected to while participating in any CIEP event or activity, including (but not limited to) its annual conference, mini-conferences, local groups, training or forums.

Please complete the form to the best of your ability in the circumstances and please don't worry if you're unable to complete it with precision.

You may choose to submit this form anonymously if you want to report the behaviour but do not want the incident(s) to be investigated.

If you do want the incident(s) to be investigated, you must include your name and contact details, as well as the names of the parties involved, including any witnesses.

The CIEP defines 'unacceptable behaviours' as including discrimination, harassment, victimisation and bullying, as well as those behaviours that result in intimidation, insult or injury.

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* 1. Your name (Please leave blank if you prefer to report anonymously, remembering that we can only record, not investigate, any incident(s) reported anonymously)

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* 2. Your involvement in the incident(s)

I felt targeted by the incident(s)

I was a witness to the incident(s)

Other (Please explain)

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* 3. Date of report Are you reporting an incident that took place within the last 24 hours?

Yes

If 'No', please confirm the date on which you are completing this report

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* 4. Please confirm the date(s), time(s) and location(s) of the incident(s) to the best of your recollection (If more than one incident, please list all instances)

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* 5. Please describe the incident(s) to the best of your ability (Please include the names of the parties involved and of any witnesses, if you know them)

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* 6. Did the incident(s) involve a director of the CIEP?

Yes

I don't know

If yes, please identify the director(s) involved and explain their part in the incident(s)

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* 7. Would you like us to investigate this report?

Yes

I'm not sure

If you've selected 'I'm not sure' and unless you're reporting the incident(s) anonymously, please indicate here when you would like us to follow up to check whether your answer to this question has changed

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* 8. Your contact details (Please supply these unless you're reporting the incident(s) anonymously)

Email address

Mobile number

Thank you for completing this form. The CIEP recognises that making such a complaint can be difficult and aims to support you sensitively.

Unless you've submitted this report anonymously, a director will be in touch soon to follow up with you. Any subsequent investigation will be conducted promptly and confidentially, fairly and sensitively, by no more than three directors. The Council will be consulted should these directors propose action as a consequence of their investigation.

If you would like support more urgently, please email a CIEP director or call the CIEP office and ask them to put a director in touch with you. You can reach the EDI director by emailing edi@ciep.uk and you can call the office on 020 8785 6155.