BH Webform

To make a report, please connect with the Anti-Bullying Specialist.

The webform below will help you provide the details of your confidential inquiry directly to the Bullying & Harassment Central Hub.

Once your webform is submitted, Anti-Bullying Specialist will determine if your experience meets the scope and jurisdiction for action under GP 47, explore support options with you, and confirm next steps, which could include submitting a report under GP 47 or submitting an anonymous allegation to the University.

For more information, please visit "What happens after I submit?"

If you are a unionized employee or connected to an employee association, you are encouraged to contact your representative before submitting a report.

Your website

Date

Your Name

Your Email

Your Phone Number

If "Other" status, please specify here

Your Department

Your Supervisor (for employees only) Not an employee? Please type n/a or not applicable

Are you sharing an experience about bullying & harassment that happened to you or that you witnessed happen to another person? Happened to you Happened to another person

Are you filing a complaint about more than one person? Yes No

Please indicate whether you want to submit this webform anonymously Yes No

Information on Anonymous Allegations

Please note that when filing an anonymous allegation, you will need to provide your contact information in order to inform you of the Responsible Office’s decision with respect to scope and jurisdiction and in case additional details are needed for that decision. Otherwise, SFU may be unable to proceed with an investigation based on an anonymous allegation due to lack of evidence.

Who is this webform about?

Name

Department

Email (if known)

Phone Number (if known)

How is the person named above connected to you?

Is the bullying or harassment based on Repeated incidents A single incident

When did the bullying or harassment begin/occur?

Describe the events (e.g., behaviour, actions, words, images and/or volume used) that have led you to submit this webform.

Where did the bullying and harassment take place? On Campus Off Campus Online

Select all that apply.

Consent & Privacy Policies

Consent to Use & Disclosure

By checking this box, I agree and understand that:

I’m submitting a Bullying & Harassment Webform to SFU's Anti-Bullying Specialist under the Bullying & Harassment Policy;
This webform submission will be used to determine whether SFU has the jurisdiction to investigation under the Bullying & Harassment Policy;
This webform submission and the information disclosed therein will be kept in the strictest confidence and may be disclosed as necessary for purposes outlined in the Bullying & Harassment Policy or as detailed in FIPPA
If a report is accepted and sent to the Responsible Office for action, then a copy of this webform may be provided to the respondent(s) (the person or people you are reporting); and
Failure to give my authorization to SFU will prevent the university from taking follow-up steps in response to my webform, including initiating an investigation.

Content to Use & Disclosure Agreement: I agree and understand.

Privacy notification

By checking this box, I agree and understand that:

The information I provide to Simon Fraser University (“SFU”) on the Bullying and Harassment Webform is collected under the authority of the University Act (R.S.B.C. 1996, c. 468), the Freedom of Information and Protection of Privacy Act (R.S.B.C. 1996, c. 165) (“FIPPA”), the Workers Compensation Act (R.S. 2019, c. 492), the Occupational Health and Safety Regulation (B.C. Reg. 296/97), SFU’s Bullying and Harassment Policy and its Health and Safety Policy (GP-17).

If you have any questions about the collection and use of this information, please contact Rana Hakami, Anti-Bullying Specialist (Office: 778-782-7166 or bhinfo@sfu.ca).

Privacy Notification Consent Agreement: I agree and understand.

SFU.CA

Bullying and Harassment

BH Webform

Who is this webform about?

Consent & Privacy Policies

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