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Climate Incident Report Form

Filing This Report

The University of Massachusetts Amherst is committed to maintaining a positive campus climate for all community members. By reporting incidents that have negatively impacted you, others, or the community, and/or are contrary to the University of Massachusetts values and codes of conduct, you are making a valuable contribution in helping to maintain the integrity and safety of the campus community as a whole.

Once you submit the Climate Incident Report, you will receive an automatic confirmation email to let you know your form was successfully submitted. Within 2 business days, staff from the Office of Equity and Inclusion will review the submission and respond to you with the email address you provide in the form. If this is an emergency situation, a crime has occurred, or you or someone else requires immediate medical or emergency services attention, please contact the University of Massachusetts Police Department (UMPD) at 413-545-2121 or dial 9-1-1.

The University strives to protect the privacy of individuals who report incidents. All information will remain private but not confidential. If you wish to speak to someone confidentially prior to reporting, please review the campus resources noted as confidential. Staff at these offices can assist you in exploring your reporting options as well as review campus resources available to you. 

Please read the OEI Response Protocol for important information on next steps after completing the form below. For additional reporting options, go to our reporting options page.
 

The name you would like us to use when addressing you
I am reporting as a(n):

Stop!

Residence Education staff members should use the Incident Report Form in Advocate.

Please Note:

You are welcome to submit this report, however RL Res Ed and Residence Security staff should complete the public incident report found here.
Please describe as specifically as possible, to the best of your recollection, your involvement in, or observation of the incident. Include any information you believe may be relevant to this inquiry. Be aware that if the incident references alleged violations of the Code of Student Conduct and/or Residential Life Community Standards, your statement may be introduced during student conduct proceedings.
Please indicate all individuals involved in this incident as well as others that could provide information related to the actions and or events being reported. Provide as much information about the individual(s) as possible, including their last name, first name, phone number, and address. If the individual is not a student, indicate their relationship to the campus if known. If you do not know the names of certain individuals involved, provide as much identifying information about them as possible.
Upload requirements
Upload requirements
Based on the details you included above, please describe your most immediate needs or concerns regarding this issue. Please list any next steps, outreach, or remediation that you would like to see, as specifically as you can.
If you have discussed or sought assistance regarding this incident with staff from an on-campus office(s), please indicate which campus offices.


By submitting, I attest that I have written the above statement of my own free will, without promises or influence, and that it is true to the best of my knowledge and recollection. I am aware that the statement will be reviewed by University staff and may result in the initiation of Code of Conduct or other official processes for involved individuals.

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