Submit Incidents Statistics
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Step 1: Give Your Report a Title
Please enter a valid title using the template or write your own

Fill Out This Template:

Or Write Out Your Own Title (approx. 45 characters):


Step 2: Describe the Incident
Please provide details on the incident

Recount What Happened

(events, circumstances, injuries, parties involved, witnesses, follow up actions, legal actions)


Add Tags so others can find Your Report

Some example tags include: Discrimination, Racism, Sexism

Step 3: More Information (optional)

When did this Happen?


Where did this Happen?

You can put in a specific room (conference area, break room), a building, a city...


Employer



Step 4: About You

Race









Gender





Ability


Step 5: Sharing Your Report

Enter your Email for Related Updates and News (optional):

Check the box below to give your consent to publish your report:


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