Workplace Violence Incident/Hazard Report

Please provide your contact details or select “Anonymous” to report anonymously

Anonymous

I would like to provide my contact details

Name

Phone

What is your affiliation with Stellar Solar? What is your affiliation with Stellar Solar?

What is your involvement with the incident? What is your involvement with the incident?

Date of incident, if known:

or if exact date is unknown, please enter approximate date:

Approximate time of incident:

Location of incident (exact address, if known, or general description of location):

Type of incident: Type of incident:

Name of alleged offender(s), if known:

First

Last

If name of alleged offender(s) is unknown, please describe the person(s) to the best of your ability:

Narrative description of incident/workplace hazard

Were there any injuries?

(please describe extent):

Was medical treatment required?

Were police notified?

Was alleged offender(s) arrested?

Please provide any other relevant information needed for our investigation of this incident:

If you are human, leave this field blank.