Report-IT

Please complete all of the fields before submitting the Incident Report.

Loading, please wait...

SEXUAL VIOLENCE AND DISCRIMINATION REPORTING

Incident Status Details

Incident Reference Number

LABEL DESCRIPTION NEEDS TO BE SHOWN HERE

Request Immediate Assistance
Contact Number*

Description*

Complainant Details
Were you directly affected by this incident? Yes
Remain Anonymous? Yes
Are you reporting an incident on behalf of someone else? Yes
Were there any other persons affected by this incident? Yes
Provide a reason for remaining anonymous

First Name
Last Name
Email Address
Cell Number
External Reference
Gender
Complainant Status
If you are a UCT staff member or student, please select your faculty/department

Incident Details
What type of incident would you like to report? *
Where did the incident take place? *

When did the incident occur? *

Day	Month *	Year *
Hour	Minute

Perpetrator Details
Perpetrator identity unknown Yes
Perpetrator identity withheld Yes
First Name Last Name Email Address Cell Number External Reference
Why is the perpetrators identity being withheld?
What is the Perpetrator Known As?
Perpetrator Gender
What is the Perpetrator relationship to the survivor(s)?
Perpetrator Status

Survivor Details
Remain Anonymous? Yes
First Name Last Name Email Address Cell Number External Reference What is the Survivor Known As?
Survivor Gender
Survivor Status

Witness Details
Were there any other persons targeted? : Yes
Remain Anonymous? Yes
First Name Last Name Email Address Cell Number External Reference What is the Witness Known As?
Witness Gender
Witness Status

Complainant Statement
Please provide a detailed description of the incident * Please select any extra relevant information
Select File(s) to upload
No File Chosen Choose Files

Confirm and Submit Details

Thank You For Reporting
We encourage you to make use of Student Wellness Services (students) or Lyra Wellbeing (staff) to seek medical assistance and psychological support and Campus Protection Services for immediate crisis safety support.

You may now close the page.
Attachment Upload Status
Email

Version 3.2