Anonymous Incident Reporting Form

Anonymous Incident Reporting Form

This form was developed in an effort to ensure that all students, volunteers, and families have the ability to report incidents of any kind anonymously to Youth Resources’ leadership.

Should you have any questions, please call the YR office at 812-421-0030.

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Please provide a detailed description of the incident you are reporting. *

When did the incident occur?

Date

Time

If you do not know the exact date/time, please describe when the incident occurred.

Number of weeks ago, time of day, etc.

Where did the incident occur? *

• At the YR office
• At a YR program event (not at the office)
• On social media
• Other

incident where Is

If other, please describe where the incident occurred.

Is it ongoing? *

• Yes
• No
• Not sure

How did you become aware of this incident? Did you witness the incident or hear about it afterwards? *

Did anyone witness the incident? If so, please list any and all witness names. *

Your Information (Optional)

First Name

Last Name

Email

Phone

Final Details

Do you wish to remain anonymous? *

• Yes
• No
• Not sure

Can YR contact you to ask further questions about this incident? *

• Yes
• No

Is there anything else YR should know? *

Submit