Concern Details
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If you or someone else is at immediate risk of harm, please stop completing this report and call 999.

Before you report

You do not need to have all the answers before you contact us. Tell us what happened in your own words and share as much or as little information as you feel able to.

Before you start, it may help to know:

  • You can report anonymously. You do not have to give us your name, email address or postcode. However it may make it harder for CIISA to respond to your report without being able to identify you. Please read our privacy notice and user guides for more information.
  • You can report something that happened to you or someone else.
  • You do not need to decide whether the behaviour breached the CIISA Standards . Tell us about your experience and we will consider the information you provide. We recommend reading our user guides before you report.
  • Share what you know. It is fine if you cannot remember exact dates, names or other details.
  • Take your time. Some of the questions may relate to difficult or upsetting experiences. You can leave the page at any time using Exit this page.
  • Your information matters. We will treat what you tell us with care and respect. You can find out more about how we collect, use and protect your personal information in our Privacy and Data Protection Notice .
Are you reporting on behalf of an organisation?
Name:
E-Mail:
Postcode: Your postcode helps us understand who is accessing our service and where we may need to improve awareness or access.
Details of concern:
When the incident(s) happened: Please tell us when the incident(s) happened. If you do not know the exact date, provide an approximate date, time period, or any information that may help us understand when the incident(s) occurred.
Location(s): Please tell us where the incident happened. If you do not know the exact location, provide as much information as you can, such as the organisation, venue, workplace, online platform, or general area.
People involved: If you feel comfortable to do so, please tell us about who was involved.
Further information you'd like to share: Please use this space to tell us anything else you think may be relevant to your report.
Information that may support your report: Please tell us about any evidence or information that may help us understand your concern. You do not need to provide it now. If it is relevant to our assessment, we will contact you to discuss it further.
What you would like to happen next: Please tell us what you hope will happen as a result of making this report. This could include support, guidance, action being taken, or simply having your concerns heard. You do not need to know what outcome is possible to complete this section.
Date of birth (Age):
Disability: Do you have any physical or mental health conditions or illness lasting or expected to last 12 months or more?
Ethnic Group:
Marital or partnership status:
Religion:
Sex:
Gender identity: Is the gender you identify with the same as your sex registered at birth
Sexual orientation: