This section establishes a unique incident record while protecting reporter confidentiality. All information is encrypted and access-controlled. Fields marked mandatory are essential for case tracking.
Incident Reference ID
Date and Time of Formal Report Submission
Date and Time of Actual Incident Occurrence
Primary Incident Location (Building, Floor, Department, or Remote Context)
Is this report being filed anonymously?
Please provide a secure alternative contact method or anonymous identifier for follow-up communications (e.g., encrypted email, third-party representative):
Reporter Full Name
Reporter's Relationship to the Incident
Direct Victim/Target
Eyewitness
Third-Party Observer
Informed by Victim
Supervisor/Manager Notifying on Behalf
Has the victim/target explicitly consented to this report being filed?
Describe how you were informed and the victim's level of awareness:
Explain managerial duty-to-report circumstances and victim notification status:
Reporter Employee ID (if applicable)
Reporter Department/Business Unit
Reporter Direct Contact Information (if consent given)
Preferred Communication Method for Updates (select all that apply)
Secure Corporate Email
Encrypted External Email
Phone Call
In-Person Meeting
Third-Party Intermediary
No Contact Preferred
Does the reporter require absolute confidentiality with no disclosure to direct management chain?
I understand that absolute confidentiality may limit certain investigatory actions and acknowledge the constraints
I affirm that the information provided is accurate to the best of my knowledge and understand that false reporting may result in disciplinary action
Provide a comprehensive account of the incident. Detailed narratives enable accurate risk assessment and appropriate response protocols. Include all relevant context, verbatim language if possible, and sequential timeline.
Incident Classification (select all primary categories that apply)
Workplace Harassment (Non-Physical)
Discriminatory Harassment
Sexual Harassment
Physical Threat or Intimidation
Verbal Threat or Coercion
Stalking or Surveillance
Workplace Violence (Actual)
Safety Protocol Violation
Retaliation for Prior Reporting
Psychological Bullying
Cyber/Digital Harassment
Substance-Related Incident
If harassment-related, specify the primary nature
Quid Pro Quo (Exchange-Based)
Hostile Work Environment
Pattern of Microaggressions
Not Harassment-Related
Detailed Incident Narrative: Describe what happened in chronological order, including specific statements, actions, and contextual factors
Estimated Duration of Incident (in minutes) or Ongoing Pattern (number of weeks/months)
Alleged Perpetrator(s) Information
Full Name or Descriptor | Role/Relationship | Department/Affiliation | Employee ID (if known) | Has this individual been previously reported? | ||
|---|---|---|---|---|---|---|
A | B | C | D | E | ||
1 | Employee-Peer | |||||
2 | Unknown | |||||
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Were there any witnesses to the incident?
Witness Details and Preliminary Statements
Witness Name | Witness Contact | Observed Actions/Statement Summary | Has witness provided written statement? | Attach Witness Statement Document | ||
|---|---|---|---|---|---|---|
A | B | C | D | E | ||
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Types of Evidence Available (select all that apply)
Email Correspondence
Instant Message/Chat Logs
Digital Photographs
Video/Audio Recording
Handwritten Notes/Letters
Medical Documentation
Police Reports
Security System Logs
Social Media Content
Physical Evidence Objects
Other Digital Artifacts
No Evidence Available
Can you provide digital evidence files at this time?
Upload Evidence Files (maximum total size 50MB, multiple files supported)
Explain evidence location and retrieval plan:
Has the perpetrator engaged in similar behavior previously, either toward you or others?
Describe prior incidents, dates, and any previous reports filed:
Has this incident been reported to any external authorities (police, legal counsel, regulatory bodies)?
Authority Name and Case/Reference Number:
Additional Context: Include any relevant background information, power dynamics, cultural considerations, or organizational factors that may be relevant to the investigation
Evaluate immediate safety concerns and implement protective measures. This section triggers real-time security protocols and duty-of-care responsibilities. Answer with current, actionable intelligence.
Is there an immediate and credible threat of physical harm to any individual at this moment?
URGENT: Activate Emergency Protocols - Notify immediately (select all)
Contact Corporate Security Dispatch
Alert Local Law Enforcement (911/999)
Notify Chief Security Officer Directly
Implement Lockdown/Evacuation
Provide Victim Immediate Safe Escort
Secure Perpetrator Location and Monitor
Activate Crisis Response Team
Has any physical injury been sustained as a result of this incident?
Injury Documentation and Medical Response
Injured Party Name | Nature of Injury | Medical Attention Received? | Medical Facility/Provider | Attach Medical Report (if available) | ||
|---|---|---|---|---|---|---|
A | B | C | D | E | ||
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Current Physical Whereabouts of Alleged Perpetrator
On-Site at Work Location
Off-Site but Actively Working
On Leave/Vacation
No Longer Employed/Contract Ended
Unknown/Uncertain
Other
Current Physical Whereabouts of Victim/Target
On-Site at Work Location
Off-Site Working Remotely
On Medical/Personal Leave
Has Left the Organization
Secured in Safe Location
Unknown
Other
Is physical separation between parties required immediately?
Specify Separation Measures (select all applicable)
Temporary Remote Work Assignment
Perpetrator Suspension with Pay
Victime Paid Administrative Leave
Physical Workspace Relocation
Schedule Modification (Different Shifts)
Restrict Access to Victim's Work Area
Building Access Badge Deactivation
Are there any existing restraining orders, protective orders, or legal no-contact directives in effect?
Legal Order Details and Enforcement
Order Type and Jurisdiction | Issue Date | Case Number | Has Security Been Notified? | Upload Certified Order Document | ||
|---|---|---|---|---|---|---|
A | B | C | D | E | ||
1 | 1/1/2025 | |||||
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Should building access for the alleged perpetrator be immediately restricted or monitored?
Access Control Action Level
Monitor Badge Swipes with Alerts Only
Escort Required for Building Entry
Restrict to Specific Zones Only
Immediate Badge Suspension Pending Investigation
24/7 Security Detail Assignment
Describe any immediate safety concerns not captured above, including specific threats made, weapons involved, or stalking behaviors:
Emergency Contact Person for Victim (Name and Relationship)
Has the victim's immediate supervisor been notified of safety concerns?
Supervisor name, date notified, and their proposed immediate actions:
Conduct formal threat assessment using standardized behavioral risk indicators. This section determines case priority, resource allocation, and intervention strategies. Complete all rating scales based on current evidence.
Threat Severity Factor Assessment: Rate each dimension on a scale of 1 (Low) to 5 (Critical)
Directness and Specificity of Threat Language | |
Perceived Intent to Carry Out Threat | |
Access to Victim/Target (Physical/Proximity) | |
History of Violent or Threatening Behavior | |
Presence of Weapon or Means to Harm | |
Stalking or Surveillance Behaviors Observed | |
Substance Abuse or Mental Health Instability Indicators | |
Organizational Impact Potential (Beyond Immediate Victim) |
Victim Vulnerability Factor Assessment: Rate each factor 1 (Low) to 4 (High)
Perceived Victim Isolation (Social/Professional Support) | |
Previous Trauma History or Sensitivity | |
Physical or Psychological Health Fragility | |
Power Imbalance (Subordinate to Perpetrator) | |
Financial Dependence on Employment | |
Language or Cultural Barriers to Seeking Help |
Overall Immediate Risk Level (1 = Minimal, 10 = Imminent Danger)
Perceived Emotional State of Alleged Perpetrator at Time of Incident
Case Priority Triage Level (Based on Above Assessments)
Level 1 - Routine (Monitor, Standard Investigation)
Level 2 - Moderate (Enhanced Monitoring, 72-Hour Action Plan)
Level 3 - Serious (Immediate Intervention, 24-Hour Security Plan)
Level 4 - Critical (Emergency Protocols, Real-Time Monitoring, Legal Involvement)
Does this case require immediate referral to external threat assessment specialists or law enforcement behavioral units?
Specify external agency, contact person, and referral justification:
Recommended Immediate Threat Management Actions (select all required)
Formal Investigation Launch (Internal)
Third-Party Independent Investigation
Victim Support Resource Coordination (EAP, Counseling)
Security Detail or Escort Assignment
Workplace Safety Plan Development
Legal Counsel Engagement
Human Resources Business Partner Notification
Executive Leadership Briefing (Confidential)
Union/Employee Representative Involvement
Media/Communications Strategy (If Public Risk)
Digital Forensics Analysis
Background Check Re-Authorization for Perpetrator
Detailed Threat Management Plan: Outline specific steps, responsible parties, deadlines, and success metrics for risk mitigation
Is ongoing behavioral monitoring of the alleged perpetrator recommended?
Monitoring Protocol Specifications
Monitoring Activity | Responsible Party | Start Date/Time | Review Date/Time | Alert Triggers/Thresholds | ||
|---|---|---|---|---|---|---|
A | B | C | D | E | ||
1 | Badge Access Log Review | Security Team | 1/1/2025, 12:00 AM | 1/8/2025, 12:00 AM | After-hours entry | |
2 | Email/Communication Monitoring | IT Security | 1/1/2025, 12:00 AM | 1/15/2025, 12:00 AM | Keywords related to victim | |
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Assigned Case Manager/Investigator Name and Title
Proposed Case Review and Update Schedule
Final authorization and accountability verification. Both designated officers must review all preceding sections, validate risk assessments, and concur on threat management plan before case activation. Electronic signatures constitute formal approval.
Date and Time of Joint Review Session
Executive Review and Approval Matrix
Officer Role | Full Name (Printed) | Official Title | Electronic Signature | Approval Granted? | ||
|---|---|---|---|---|---|---|
A | B | C | D | E | ||
1 | Head of Employee Relations | |||||
2 | Chief Security Officer | |||||
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Do both officers concur with the assigned Risk Level and Threat Management Plan?
Document points of disagreement, alternative risk assessment, and resolution plan:
Is escalation to C-Suite or Board Level required due to extreme risk or organizational impact?
Specify escalation path, executives to be briefed, and communication strategy:
Final Case Disposition Decision
Approved for Active Investigation
Approved with Modifications (See Comments)
Deferred Pending Additional Information
Referred to External Agency (Investigation Halted)
Closed Without Investigation (Justification Required)
Joint Review Comments and Additional Directives: Include any supplemental guidance, resource commitments, or strategic considerations
Next Formal Review Date for Active Cases
Both officers have reviewed all evidence, witness statements, and safety assessments in their entirety
We certify that all decisions comply with organizational policy, ethical standards, and applicable legal frameworks to the best of our knowledge
Case Archival Location and Access Control Level
To configure an element, select it on the form.