Caxy Workplace Incident Report

How would you like to file this report?

Choose how you want to be identified. Both options are taken equally seriously.

Anonymous Report

Your identity will not be recorded. We cannot follow up directly, but we will investigate the concern and track patterns.

Official Report

Your name is on file. HR will follow up with you directly. Required for formal investigation and disciplinary process.

This will only be visible to HR and relevant leadership.

Full Name

Role / Team (optional)

Describe what happened. Be as specific as you can.

Date of Incident (approximate is fine)

Location

What happened? Who was involved? (names or descriptions) Were there witnesses? (optional)

Help us understand the scope of the concern.

Is this a one-time incident or a pattern? How has this affected you or your work? (optional) What outcome would you like to see? (optional)

Retaliation against anyone who files a report is illegal and will result in disciplinary action up to and including termination.

For physical submissions: Place this form in a sealed envelope and deliver to HR. Mark the envelope "CONFIDENTIAL - HR ONLY."

Thank you for coming forward. Your report has been received.

HR will review this report within 2 business days.

If you are in immediate danger, call 911.