Diversity and Inclusion Incident Report

Missouri S&T Value

We are an inclusive, welcoming community.  We seek to build a creative learning environment marked by openness, understanding and valuing all people and perspectives.

Introduction

Please report any incidents of discrimination, bias, or unfairness you have experienced or observed. In addition, please tell us about any incidents you have experienced or observed that impede our campus from being an open and inclusive environment.

We appreciate you reporting this incident.  Please understand that the more information you can provide, the better we will be able to conduct a thorough investigation and make an informed decision on the incident.   We will take into consideration the reporting party’s wishes on how they would like the incident to be handled, however there may be times when the University’s obligation to effectively address discrimination may conflict with the reporting party’s wishes.

Who can submit a report? 

Anyone:  staff, faculty, students, parents, alumni, and visitors to the campus.

What happens after I submit a report?

Missouri S&T takes these reports seriously and will take action to investigate reported incidents and determine the appropriate action.  We also provide support to all members of the campus community who experience, or witness, such an incident.  The offices of Counseling, Disability Support and Student Wellness; Student Advocacy; Office of Student Affairs; and Human Resource Services, Affirmative Action, Diversity & Inclusion provide a wealth of resources.

Can I submit a report anonymously?

Yes, the identifying information below is optional. Without this information, the form will be submitted anonymously. If you supply your name and contact information this initiates the informal investigation process, and the Human Resource Services, Affirmative Action, Diversity & Inclusion (HRSAADI) office will contact you to follow up on the incident. If you want to act responsibly and report an incident but don’t want to give your name the HRSADDI office will still investigate the incident. Also, if you do not feel comfortable submitting this information online you can print this form and send it via campus mail to HRSAADI Office, 113 Centennial Hall.

Incident Report Form




1.What transpired during the incident? Please check all that apply:

Verbal Assault Harassment Vandalism
Theft Unequal Treatment Accessibility
Discrimination E-mail/Text Messages/Facebook Physical Contact
Written Hate Speech Bullying Threats
Public Indecency Stalking Intimidation
Physical Assault Retaliation Sexual Assault
Unwanted Sexual Conduct Graffiti Fear for Safety
Property Damage Pursuit-Chase Threat of Outing
*Other

*If other, please specify:

2. Do you believe that any of the following factors contributed to your incident?
Age Disability Race
Ethnicity Gender Nationality
Religion Retaliation Sexual Harassment
Pregnancy Sexual Orientation Gender Expression
Political Affiliation Socioeconomic Class Physical Appearance
Veteran Major of Study
*Other

*If other, please specify:

3. The date and time the incident occurred.
Date: Time:

4. Where the incident occurred:

5. In the following text box, please describe the incident as completely as possible.
Provide all relevant descriptions, including who was there, and, if known, whether participants are faculty, student, or staff; what the sequence of events was; and what if anything was said.

6. Who else, if anyone, has been notified about this incident?

7. Your association with the incident (victim, witness, other):

8. How long do you think this problem has been going on?

9. Do you suspect or know that a supervisor or management is involved?

10. Which of the following S&T channels of informal resolution have you gone through already, if any? If you are comfortable please do list the individuals you have spoken to regarding this situation.
Channel:
Contacts:
11. Your affiliation with S&T:
If other, please specify:
12. How did you find out about the bias incident reporting form?
If other, please specify:
13. In your opinion, how should this incident be resolved or what should be the final outcome?
14. What follow up do you prefer, if any?  Email, phone, meeting, other.
Provide contact details with preferences:

I confirm that all information presented in this report is accurate and correct to the best of my knowledge and ability.

Date:

 

Note: As stated previously, identifying information is optional. Without this information, the form will be submitted anonymously.

If you provide your contact information, we will contact you to follow up on this report. If you do not provide contact information, there is no way for us to identify who is submitting this report; however, once a report is received the appropriate office will conduct a thorough investigation to resolve the incident.

If we subsequently contact you, it will be because you were identified through the investigation, not because you submitted the anonymous bias report. Read more about the informal inquiry and investigation process here (Policy Memorandum I-29).

We sincerely thank you for taking the time to report this incident, as we cannot address these issues if no one speaks up.  As we work to create a more inclusive campus environment it is vital for community members to speak up about what they witness or experience on our campus. 

We will do our best to find a productive resolution to this incident and any others that are reported.