Items marked with a diamond ♦ are required fields.
Incident Details
Incident Description
♦
Provide as much detail as possible regarding this incident/concern.
(WHO, WHAT, WHERE, and WHEN, if known)
♦
Date/Time of the incident/concern.
(Ex: “Monday, April 2nd in the afternoon; the week of May 23rd ; sometime in May of this year”.)
Previously Reported
♦
Indicate the office/individual you communicated with.
Incident Location
Campus, School, Department, & Area
Boston
Fenway/SMFA
Grafton
Medford/Somerville
Other
(Select One)
Select Campus 1st
(Select One)
Athletics
Campus Housing
Classroom/Lab
Clinical Rotation, on campus
Clinical Site
Clubs on campus
Culture/Identity Groups
Department
Dining Hall
Fraternity/ Sorority
Laboratory
Social Event
Study Abroad
University sponsored event/program
Other
(Select One; Provide any additional specifics in the "Location/Address" field below.)
Identification & Contact Information
Name & Contact Information
♦
Relationship to the University
Undergraduate Student
Graduate Student
Faculty
Staff
Alumni
Contractor
Family Member of Student
Friend of Student
Patient
Trustee
Unknown
Vender
Visitor
Other
(Select One)
Include the area code, extension,
and/or dialing codes if applicable.
Phone Number (Alternative)
Include the area code, extension,
and/or dialing codes if applicable.
Participants (Including but not limited to the responsible parties, victims, witnesses, and/or others.)
Acknowledgements
Non-Retaliation Statement
Any member of the Tufts University community has the right to raise concerns or make a complaint regarding discrimination, harassment, or sexual misconduct without fear of retaliation.
It is a violation of Tufts University policy to retaliate against an individual for filing a complaint of discrimination, harassment and/or sexual misconduct or cooperating in an investigation of alleged discrimination, harassment and/or sexual misconduct. Any person at Tufts University found in violation of this policy is subject to disciplinary action up to and including termination of employment or expulsion from school.
If you have any questions or concerns about this non-retaliation statement please contact Jill Zellmer, Director of the Office of Equal Opportunity by email at jill.zellmer@tufts.edu or 617-627-3298.
Password
Password
(Passwords must be at least four(4) characters in length.)
Submit
Please allow 48 hours for Tufts University to review and respond to your incident. If you feel this issue requires more immediate action please contact TUPD at 617-627-6911 or x66911
When you submit this report, you will be issued a Report Key. Please write this information down along with your password, in a secure and private place. Neither your report key, nor your password, can be recovered, or reset once this report has been submitted.
Using your Report Key and Password you can "Follow-Up" on this report by logging into tuftshelpline.ethicspoint.com
Follow-up will allow you to:
Upload documents
Response to follow-up questions
Provide additional information