Mistreatment Report

An environment that optimizes learning and is built on respect and dignity is our expectation. The way we treat other (faculty, students, residents, staff) either realizes this expectation or it interferes with the learning process. Discrimination, humiliation and harassment simply can't be tolerated. Please fill out this electronic form to report any incidents or concerns regarding mistreatment or harassment. This form can be submitted automatically by clicking on the 'Submit Form' button at the bottom of the page. This process can be anonymous, if you so choose, and the accused party will never see this report.

1) Please describe the incident you wish to report:

2) When did the incident take place (approximate time frame is fine)?

3) Where did the incident take place?

4) In which program did the mistreatment incident occur?

MD MD/MPH MD/PhD MPH Other

5) If you are comfortable in doing so, can you please provide your name?

6) Can we contact you for more information?

Yes No

7) What is the best/preferred way to contact you (e.g. email address; phone number)?

8) What do you see as an appropriate outcome?

9) Please type what you see below (case sensative).