Incident Report Form

IF THIS IS AN EMERGENCY, please call security (Ext. 5555) or 911.

Please complete as much information as possible. The timing and manner in which the Lab responds to this report will vary depending on the information provided and whether you wish to remain anonymous.

This form can be used to report an incident involving an alleged violation of:

  • EEO Policy - Policy prohibiting discrimination, harassment, and retaliation in the workplace, and setting forth the Laboratory's procedures for handling complaints relating to alleged discrimination, harassment, and retaliation.

  • Interim Title IX - Title IX of the federal Higher Education law prohibits discrimination on the basis of sex in any education program or activity receiving federal assistance.

  • Whistleblower Policy - Policy outlining reporting procedures and protections available to CSHL employees (current or former), independent contractors, volunteers and students who seek to report workplace activities reasonably considered to be illegal or dishonest.

Your Information

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Involved Parties

Incident Information

Supporting Documentation (optional)

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