PRIVACY & DATA USE

Report without identifying details.

This form asks about the setting, your role, the encounter, its impact, and the response. It does not ask for names or contact information.

What is recorded

When you submit, the site records your selected answers, narrative, a receipt reference, and the submission time. Responses are stored for review by the site operator and are not published on this website.

What to leave out

Do not include patient or staff names, medical record numbers, room numbers, exact addresses, telephone numbers, email addresses, or other identifying details. Automated checks may catch some identifiers, but you must review your answers before sending.

Before you submit

Your answers stay in the current page until you submit. The form does not save a draft to browser storage. Closing or refreshing the page can discard an unfinished report.

Technical information

The submission service uses a one-way keyed hash of your network address to limit repeated submissions. The raw address is not stored with your report. The hosting and database providers may process technical request information to operate their services.

Administrator sign-in

Public reporting does not require an account. Administrators sign in through the same account service used by FirstResponderViolence. This site uses an eight-hour session cookie to keep administrators signed in; the cookie is limited to this site.

Voluntary reporting

You choose whether to submit. This is not an emergency or official reporting channel, and it does not automatically contact your employer or emergency services. Avoid including information that could identify you or someone else.