Informal report

This form is for students and staff to use. It is confidential and as an informal reporting mechanism, it is not suitable for use as part of a formal reporting or complaints process. If you wish to instigate a formal complaint, please see our formal reporting options.

What will happen if I submit an informal report?

A member of the Equality, Diversity and Inclusion (EDI) team will respond to you within 3 working days to request further details.
You do not have to respond to this request, but if you do it will help the team to signpost you to the relevant support.
If you do not want to be contacted after making a report, you can use the anonymous reporting form.

How we will use your information

Any specific information you provide will remain confidential, and will not be passed on to anyone else without your permission.
In exceptional circumstances, if you provide further information which indicates an unacceptable risk to an individual or the University, we may share this information with relevant partners in line with safeguarding.
Information provided is stored centrally and securely with the EDI team.
The University will use the information you provide to signpost you to the appropriate support and help us understand what kind of incidents are taking place in our community.
Anonymised reports on the data received will be considered by the University Inclusion Group, University Executive Board (UEB) and Council, and published annually online in the EDI report.

About you
Your name *
How can we contact you? Please provide an email address or phone number * ?	Please provide a valid email address. We can only take action as a result of an informal report if we have up-to-date contact details, otherwise use the Anon Reporting tool.
Are you reporting on behalf of yourself?
Information about you:
If reporting on behalf of someone else, who are you reporting on behalf of?
If reporting on behalf of someone else, are you a:
If you’re a Dignity and Respect Advisor or an Advice Unit Advisor, how many minutes did you spend on this case?
What is your level of study?
What is your fee status?

About the incident(s)
When did the incident(s) take place? ?	It's ongoing In the last week In the last month In the last year Between 1-5 years ago Over 5 years ago I don't know Prefer not to say If there has been more than one event please use the most recent date.
Where did the incident(s) take place? ?	If there has been more than one event please use the most recent place.
Which campus?	Streatham St Luke's RD&E Penryn Truro Prefer not to say
What type of space was it?	Teaching space Admin space Office space Social space University accommodation Other Prefer not to say
Which city?	Exeter Penryn/Falmouth Truro Prefer not to say
What type of location?	Fieldwork Placement Studying abroad Other Prefer not to say
Was the incident connected with a specific College, service or society?
Was the incident connected with a specific directorate?
Was the incident connected with a specific discipline?
Was the incident connected with a specific discipline?
Was the incident connected with a specific discipline?
Was the incident connected with a specific discipline?
Was the incident connected with a specific discipline?
Was the incident connected with a specific discipline?
Was this the first or a repeat incident?	First Repeat I don't know
Have you already submitted an anonymous report about this incident? ?	No Yes The anonymous reporting form can be found at www.exeter.ac.uk/speakout/report/anonymous/

What was the behaviour experienced? (Please tick all that apply. Click the question marks for definitions)
Harassment ?	Bullying Online Physical Racist behaviour Sexual Stalking (in person or online) Verbal Other harassment Unwanted conduct on the basis of a protected characteristic which has the purpose or effect of violating an individual's dignity or creating an intimidating, hostile, degrading, humiliating or offensive environment for that individual.
Direct or indirect discrimination ?	Less favourable treatment regarding social activities Less favourable treatment regarding teaching and education Less favourable treatment regarding access to employment opportunities Other discrimination Being treated less favourably than someone else because of a protected characteristic, or because you associate with someone who has a protected characteristic, or where there is a rule in place which disadvantages people with a protected characteristic.
Violence and abuse ?	Controlling or coercive behaviour Domestic violence or abuse Hate crime Intimidating behaviour Physical misconduct (hitting, pushing, spitting) Sexual violence or abuse Other violence or abuse The intentional use of power or physical force, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation.
I don't know
None of these
Prefer not to say

What do you think was the reason for this incident? (Please tick all that apply)
My / the target's:	Age Disability (including hidden disabilities and mental health) Gender reassignment/transgender Marriage or civil partnership Pregnancy or maternity leave Race (including colour, nationality, ethnic or national origin) Religion, belief or lack of religion/belief Sex Sexual orientation I don't know None of these

About this tool
Was this reporting tool easy to use?	Yes No
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