Harassment Report Form

All of the questions within this form are optional but please try to include as much detail as you can.

Your contact details will only be known to authorised Students’ Union Staff who will receive this form once it has been submitted and will talk through your options moving forward.

Your details will not be passed on any further until the Authorised Students’ Union Staff member has made contact with you after receiving your form and you give your consent for that to happen – unless they believe you are in immediate danger.

If you still do not wish to leave your details, please make a note of the date when you submit this form to use to get back in touch with us if you wish to follow this up at some point in the future.

         

2. What do you identify as?





4. When did the incident occur? Please give approximate times if you're not sure
/ /   :
5. Where did the incident(s) take place? (Please specify details below)







9. Are there any other relevant details or concerns relating to the incident which you wish to provide? (For instance: friends or family finding out about the incident/ STIs or pregnancy as a result of the incident/ your personal safety as a result of the incident)


A reminder that your contact details will only be known to authorised Students’ Union Staff who will receive this form once it has been submitted and will talk through your options moving forward.

Your details will not be passed on any further until the Authorised Students’ Union Staff member has made contact with you after receiving your form and you give your consent for that to happen – unless they believe you are in immediate danger.

If you still do not wish to leave your details, please make a note of the date when you submit this form to use to get back in touch with us if you wish to follow this up at some point in the future.

Share this page: