Sexual Harassment and Other Sexual Misconduct Incident Report

Background Information

Please fill out as much information as possible.

Your full name:

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Or, you may write Anonymous

Your position/title (if any):

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If you are a mandatory reporter, please add your position or title at Ohio University.

Your phone number:

Your email address:

Email address must be of a valid format.

Your physical address:

Date of incident (Required) :

This field is required.

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If you do not know the actual date of the incident, please use the date it was reported to you.

Time of incident (if known):

Location of incident (Required) :

This field is required.

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Regional Campuses and Centers are at the end of the list

Specific location (if known):

Involved Parties

Please provide the names and roles of individuals or organizations involved in the incident. Please complete as much of the other requested information as possible. Click the button labeled Add Another to include more people.

Name

Select Role

Student PID # or Employee ID #

DOB (YYYY-MM-DD)

Phone number

Email address

Hall/Address

Questions

Please provide as much information as you can. If there are questions you cannot answer or information you are uncomfortable sharing in this format, please state that in the appropriate field.

If you are a third-party reporter, please describe how you came to know the information you are reporting. Please include when, where, how, and from whom you learned the information. (If you are making a report for yourself, please note that here.) *** Additional questions below will ask what you know about the incident. (Required) This field is required.

If known, when and where did the incident being reported take place? (Required) This field is required.

Please provide as many details as you can regarding the incident and any other information that could be helpful. (Required) This field is required.

Was medical treatment sought related to this incident? (Required)

Yes No Unknown

This field is required.

Was law enforcement involved in this incident? (Required)

Yes - Athens Police Department Yes - Ohio University Police Department Yes - Other Police Agency No Unknown

This field is required.

Supporting Documentation

You may upload supporting documentation in .pdf format. This could include photos, text messages, emails, etc. Please convert files to .pdf format before uploading. 5GB maximum total size. Attachments require time to upload, so please be patient after submitting this form.

Sexual Harassment and Other Sexual Misconduct Incident Report

Background Information

Involved Parties

Questions

Supporting Documentation

Submission

Contact Information:

Ohio University Contact Information: