Unreasonable Behaviour Report Form

Unreasonable Behaviour Report Form

Use this form if you believe you are experiencing or seeing sexual harassment or bullying at one of our events, workshops, labs or job placements and would like to lay an informal complaint, please record the events of the incident as accurately as possible.
This form will be passed onto the Executive Director – Jackie Dennis who will follow up with you as soon as practical. In serious cases, you can request to meet with Jackie directly.

If the Executuve Director is the subject of the complaint, fill out this form and contact our Programme Manager, Eloise Veber at Eloise@script-to-screen.co.nz who will then action your complaint with our board.
Name

First NameLast Name
When did it happen?

DayMonthYear
Date
Time

:HourMinutesAM/PM Option
Where did it occur?
Who was present?
What was said and who said what?
Why do you think the incident was bullying and/or sexual harassment?
It's unreasonable because:
It endangered my health or safety because:
Who witnessed the incident?
What impact did this incident have on you?
How has this incident affected your work?
Have you taken any actions? If so, how?
As a result of this complaint, what do you want to see happen?
Should be Empty: