Please complete this form if you feel you have experienced discrimination, abuse or microaggressions when accessing support from - or working at - Amaze. This may have been related to race, ethnicity, religion, belief, disability, sex or gender, sexual orientation, age, marriage and civil partnership, pregnancy and maternity, or being trans or non-binary.
If you have experienced these things when accessing any other service, we strongly encourage you to report this to that particular service directly. However, if you don’t feel comfortable doing this, you can complete our form and we will report it on your behalf.
Please complete the questions below, or download an
incident report form [.doc 31kb] and email it to our CEO Rachel Travers at firstname.lastname@example.org, or another member of staff if you would feel more comfortable.
Did this incident happen at Amaze?
If no, which service/organisation did it happen at?
If it was at Amaze, which service were you accessing, or trying to access? (Or if you are an employee or volunteer with Amaze and this happened at work, which team was involved?)
Date of incident
Time of incident
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What does the incident relate to? (Tick all that apply)
What happened? (Tick all that apply)
In order to enable us to respond to your enquiry without having to contact you for more information, please be as specific as possible with the information that you supply.
Please give details of exactly what happened during the incident
Have you experienced this type of incident at Amaze before? (Or if you are reporting an incident that happened at a different service, have you experienced this type of incident at that service before?
If yes, please tell us how many times
Were there any witnesses to the incident?
If yes, please provide details of any witnesses
Is there anything else you'd like to add?
If you are reporting an incident with a different organisation/service, are you happy for us to share with them the information you've provided here
If you are human, leave this field blank.