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SELF Incident of Concern Form

Scope of Reports

Incident reports are used to determine if someone should be removed from their board, staff, or volunteer position, denied entry, removed from the event, or have their invitation to present, judge, or host revoked.

Commitment to Empathy and Mutual Responsibility

SELF is committed to fostering an environment of respect, dignity, inclusion, and safety. Recognizing that individuals bring diverse histories, identities, and experiences into shared spaces, this policy clarifies what SELF will address and where the boundaries of responsibility lie, while approaching all concerns with empathy and professionalism.


SELF affirms that feelings of offense or distress are real experiences, but responsibility for addressing them must be shared. The event is responsible for addressing discriminatory or harmful conduct, not for eliminating all discomfort or disagreement. Our goal is to balance psychological safety, freedom of expression, and fair process, in line with established professional standards from multiple disciplines.


Please note that SELF does not mediate disputes between partners or individual event attendees, and does not facilitate apologies. SELF is not a professional mediator or apology assistant, either publicly or privately.

Complete Reports

Please complete this form in its entirety. This form cannot be saved and must be completed in one session. The form should only be completed by a person with firsthand experience of the incident. You are the person most familiar with the situation. You know the witnesses, you have knowledge of any prior documentation that might exist, and you have an idea of where to find it. Please be prepared to supply needed proof to SIAT (SELF's Incident Assessment Team).


Incomplete forms may result in a delayed response or a need for you to provide further actionable information. Incomplete information limits our ability to provide appropriate follow-up. SELF understands it takes work to make a complete report and thanks you for helping create a safer event. SELF, without you, is unable to know difficulties which occur at the thousands of events held locally and nationally. Without your complete reports we are not as safe as any of us want to be.


SELF does not accept anonymous submissions and only reviews first-person reports, not secondhand or third-party information.

SELF is unable to take any action on reports that are provided for informational purposes only. If you are not expecting SELF to take any action, please do not submit this form. If your report is "so-and-so did this just wanted you to know" this is not an actionable report. No action will be taken which lacks specificity and proof.


After Report is Filed
SELF will conduct an initial review to determine whether the report falls within the Incident Assessment Team’s defined scope. Acceptance of a report does not mean that SELF has concluded that a violation occurred. When an inquiry is warranted, team members without a material conflict of interest will seek to establish a fair, impartial, and fact-based understanding of the reported events by reviewing available evidence, requesting clarification, interviewing relevant witnesses, and ordinarily giving the person reported a reasonable opportunity to respond to the material allegations. SELF may take temporary safety measures while an inquiry is pending; these measures are not findings of wrongdoing. After reviewing the available information under SELF’s stated evidentiary standard, SELF will determine whether its policies were violated and whether action within its authority is appropriate.


SELF will protect the privacy of reporters, witnesses, affected persons, and persons reported to the extent reasonably possible, but cannot guarantee complete confidentiality. Information may be shared when reasonably necessary to conduct an inquiry, implement safety measures, comply with the law, respond to legal process, or address a credible safety risk.


SELF generally does not publicly disclose investigative details or outcomes. When another event or organization responsible for participant safety requests relevant information—or when SELF determines that a credible and substantial community-safety concern requires disclosure—SELF may provide limited, good-faith information to appropriate recipients with a legitimate need to know. Any disclosure will distinguish allegations from established findings and will be limited to information SELF reasonably believes is accurate, necessary, and appropriate.


If information received by SELF provides reasonable cause to suspect that a minor or legally protected vulnerable adult has experienced abuse, neglect, exploitation, or an immediate threat to safety, SELF will promptly report the matter to the appropriate governmental or law-enforcement authority in accordance with applicable law. SELF’s internal process is not a substitute for emergency services, law enforcement, child protective services, adult protective services, or other legally authorized agencies.

SELF will comply with valid subpoenas, court orders, mandatory-reporting requirements, and other applicable legal obligations. When there is an immediate threat to any person’s safety, SELF may contact emergency services or law enforcement without waiting for its internal inquiry to conclude.


Retaliation against anyone who makes a good-faith report, supplies information, or participates in an inquiry is prohibited and may independently result in action by SELF.

Your Name *
Your Email Address *
Your Phone Number *
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    What is your preferred method of contact?
    Phone Call
    Text Message
    I agree to be called and texted by SELF:*
    Yes
    No
    Who is this concern regarding (please choose one)? *
    Please select the area of concern: *

    On the next page of this form, you will be asked to provide detailed information regarding your concern including the name of the person of concern, the reasons for your concern, and names and contact information for others who may also have information related to your concern. If you are not willing to provide this information, the SELF Incident Assessment Team will not be able to follow up on your concern. Please only continue to the next page if you agree to share full information.

    Please click on the "Next" button to continue.

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    Legal name and scene name of the person of concern. *
    If appropriate, social media names and channels of the person of concern. *

    When listing witnesses, please secure their consent and ensure they are willing to speak with representatives of the SELF Incident Assessment Team.

    Name of Witness #1 *
    Contact Information for Witness #1 *
    What is Witness #1 attesting to:
    Name of Witness #2
    Contact Information for Witness #2
    What is Witness #2 attesting to:
    Name of Witness #3
    Contact Information for Witness #3
    What is Witness #3 attesting to:
    Provide the names and contact information for any additional witnesses.
    I verified and have the consent of every witness listed to provide you with their information. The witnesses have agreed to talk to SELF.
    Yes
    No
    Has the person you are reporting been banned by other organizations or events? How do you know they are banned? If so, please name the event, approximate date they were banned,  provide contact information for the event, or a link to the event, or the link/announcement that this person was banned. If you are uncertain, please email the organization/group/event and ask them directly so you may share solid information with us which we can vet.
    Date(s) of the incident(s) and locations where they occurred:
    What harm resulted from the incident? Who was harmed? Is the person harmed willing to provide a detailed account of what occurred? *
    Were any steps taken to resolve the situation with the parties involved?   *
    Did any criminal charges result from the incident? If so, do you have documentation of this? (SELF recommends that if you know of such documentation that you gather it prior to making this report so you can turn it over to us when we contact you.)  *
    Was any restorative action taken? If so, what was the outcome of that process?   *
    Provide a detailed report of the incident(s) which pertains to the previous questions:


    Attach your supporting documentation:

    Please attach any supporting evidence, including photos or screenshots that clearly show speaker names, relevant messages or letters, links to the original websites or sources, and any additional documentation that supports your report. Please be as complete as possible.

    Please attach all photos, court records,
    Drag & Drop Files Here Browse Files


    Agreements and Disclosures

    I understand that SELF does not offer professional mediation, assisted apologies between parties, or restorative justice services. Please seek a professional if this is what you need and/or your goal.  *

    I have read and agree to the above. 

    I understand that SELF does not offer legal assistance,  medical care, or mental health services. Please seek a professional if this is what you need.  *

    I have read and agree to the above. 

    I agree that filing this form does not guarantee any type of outcome, action, or narrative. Submission of this form should NOT be communicated to another event/organization/person in any way that implies any action has been or will be taken, until such time as the inquiry has been completed and official action, if warranted, has been taken.  *

    I have read and agree to the above. 

    If the outcome of an investigation results in a person being banned by SELF, I am allowed to report this to other organizations, events, and individuals and may invite them to verify this information with SELF directly.  *

    I have read and agree to the above. 

    I understand that if I am asked for information and do not provide it—or indicate that I need additional time—within two months of the request, SELF will consider the report closed and no further investigation will occur. *

    I have read and agree to the above. 

    I understand that if I provide information to SELF that is proven to be false through witness interviews or other verifiable documentation, SELF will report that the claims were found to be false if asked by organizers of other events. Please do not attempt to weaponize SELF to settle your personal disputes. *

    I have read and agree to the above. 

    I understand that SELF has final decision-making authority in determining any consequences that may arise as a direct result of the report. *

    I have read and agree to the above. 

    I understand that SELF does not make reports or their findings public, nor will SELF publicly announce the results of an inquiry unless it determines that doing so is necessary.  *

    I have read and agree to the above. 

    I understand that all incident reports submitted to SELF will be handled in an appropriately confidential manner. Submitting a report does not entitle the reporting individual(s) to information related to any inquiries made by SELF staff during the information-gathering process. This includes, but is not limited to, discussions held with witnesses, the names of witnesses, and the results or actions taken. *

    I have read and agree to the above. 

    I understand that reports received during the event about incidents that did not occur at SELF cannot receive a full inquiry during event weekend. SELF needs time to review statements, speak with witnesses, and gather additional information before reaching an effective conclusion. These reports will be addressed after the event. *

    I have read and agree to the above. 

    I understand that reports received within 21 days of the event may not receive a complete response before the event begins. Reports received immediately after the event will be addressed once event staff return from the post-event break. Incidents cannot be effectively resolved when the process is rushed or event staff are exhausted. Everyone who makes a report will receive an email when staff are able to begin the inquiry. *

    I have read and agree to the above. 

    Process:
    1. The reporter determines whether the concern falls within SELF’s limited scope and gathers firsthand, actionable information. 

    2. The reporter completes the form in one session, including witnesses, evidence, dates, locations, and requested action. 

    3. SELF screens the report for scope, completeness, conflicts of interest, immediate safety concerns, and mandatory-reporting obligations. 

    4. When an inquiry is warranted, SELF verifies the information, reviews evidence, interviews relevant people, and ordinarily gives the person reported an opportunity to respond. 

    5. SELF evaluates the available information under its published evidentiary standard and decides whether a policy violation is established. 

    6. SELF takes proportionate action within its authority and may impose temporary safety measures before reaching a final determination. 

    7. Information and outcomes remain private except when limited disclosure is necessary for the inquiry, required by law, requested by an appropriate safety organization, or justified by a credible community-safety concern. 

    8. Retaliation is prohibited.

    I have read and agree to the above. 

    Thank you for providing solid, verifiable information and evidence to SELF and assisting in creating safer communities. We are committed to maintaining a safer event.

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    SELF is an adult educational, fundraising, & social convention that supports lifestyles & health of consenting adults. Four days of exploration, invigoration, & conversation.