SUMMIT

REPORTING FORM FOR SEXUAL OR OTHER HARASSMENT

You do not have to use this form to receive assistance

The intention of this form is to provide Summit attendees with a mechanism to report harassment or other forms of harm. This form is not intended to be used to receive immediate assistance or support.

If you believe you have been harassed by any member of the Summit community or while participating in a Summit program or activity, you are encouraged to bring it to the attention of the Incident Council (“IC”) or any other Summit team members, such as your Curator.

The Incident Council is an internal team at Summit trained to adjudicate incidents and keep our community safe for all members. The Incident Council have signed non-disclosure agreements and will keep these reports confidential. The Incident Council is supported by advisement and recommendations from community members on best next actions for incident categories and case types.

This form is to assist with reporting an incident to the IC. While it would be helpful for you to fill out this form, you are not required to do so in order to report an alleged incident of unlawful harassment.

The IC is available to provide you with answers to questions you may have about the process and your options, advice and/or referrals. [Email questions to report@summit.co] You are not obligated to provide your name; however, the ability of the IC to take action against an alleged harasser may be more difficult based on an anonymous report. Whatever your decision, the IC or Summit team members are available to assist you in stopping the unwelcome and unwanted conduct.

Print version available here .

Name (optional)

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Name of person accused of harrassment

First Name

Last Name

Date(s) of alleged incident(s)

MM

DD

YYYY

Location(s) of alleged incident(s)

Were you able/comfortable to address your concerns with the person(s) whom you are accusing of harassment?

Yes

No

Have you reported this or similar behavior before? If so, please indicate to whom and when reported.

Provide a detailed description of the incident, answering the questions who, what, when, where. Include all pertinent facts such as: what force, if any, was used; any verbal statements (i.e., requests, demands, threats, etc.); what, if any, physical contact was involved; what you did in response to the situation, etc. You may use the back of this form or attach additional pages, if necessary.

If applicable, include a description of impact the incident has had on you.

Did anyone witness the incident?

Yes

No

Unsure

If yes, could you please provide the name of the individual who witnessed the violence, and contact information, if any.

Does anyone have knowledge of the incident?

Yes

No

Could you share who this was and their contact information, and what knowledge they have?

What action would you recommend Summit take in response to this report?

I hereby certify that the foregoing information is true, correct and complete to the best of my knowledge and belief.

Confirm

Your name (signature)

First Name

Last Name

Today's date

MM

DD

YYYY

If you prefer, you may email this report form with the Subject stating “Confidential” to report@summit.co.