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“Empowering People to find positive solutions to conflict”

Serving Clark County WA and Multnomah County OR

Incident Report

Community Mediation Services is committed to maintaining the highest standards of integrity, transparency, and accountability. We encourage employees, volunteers, contractors, and stakeholders to report any known or suspected wrongdoing or unethical behavior.

Please complete all required fields!

This form is for internal organization use only. Please do not use this form if you require services from Community Mediation Services.

First Name(*)

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Phone Number(*)

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Last Name(*)

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Email Address(*)

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Relationship to the Incident:(*)

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Incident Details: 

Date and Time of Incident(*)

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Description of Incident:(*)

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Location of Incident:(*)

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Alleged Wrongdoing:

Alleged Wrongdoing:

Fraud
Corruption
Harassment
Discrimination
Unethical Behavior

Misuse of Resources
Safety Violations
Environmental Violations
Other (fill out other field below)

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Other

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Witnesses (if any):

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**Note** Please remember that submitting a false or malicious report may have serious consequences. This form is meant to promote transparency and address legitimate concerns and grievances within the organization.

I hereby certify that all statements and information provided are true, complete, and correct to the best of my knowledge.(*)

I hereby certify that all statements and information provided are true, complete, and correct to the best of my knowledge.

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