SafeWatch
 

SafeWatch Report Form

If this is an emergency or requires an immediate response please call 911 for the police.

In the Virginia Tech community there are people who have information about incidents that adversely affect campus climate but have not made a report. This online form allows an individual to report the information while having the opportunity to select a level of privacy. As a community we have pledged to be responsible and therefore to report incidents of prejudice and discrimination on age, color, disability, gender, national origin, political affiliation, race, religion, sexual orientation, and veteran status as outlined in the Virginia Tech Principles of Community.

The only condition under which an attempt would be made to track an anonymous report is if it indicates that someone is in immediate danger. Otherwise, this information is kept confidential to the extent permitted by law and is used to heighten awareness of campus climate issues occurring at Virginia Tech.

General Information

Please indicate your affiliation to Virginia Tech:
Undergraduate Student       Faculty       Visitor / Guest
Graduate Student       Staff                  

Please indicate your gender:
Male       Transgender
Female       Questioning

Report Information

Please indicate what the incident involved: (check all that apply)
   Discrimination    Harassment / Threat    Graffiti / Vandalism
Age Age Age
Color Color Color
Disability Disability Disability
Gender Gender Gender
National Origin National Origin National Origin
Political Affiliation Political Affiliation Political Affiliation
Race Race Race
Religion Religion Religion
Sexual Orientation Sexual Orientation Sexual Orientation
Veteran Status Veteran Status Veteran Status
   
Assault Other
Verbal Classroom Behavior
Physical Public Demonstration
Sexual Hazing
  Retaliation
Stalking Weapon
Physical Other:  
Cyber

Report Description
All information from this point forward is optional.

Please give the date and time of the incident:

Suspect's Name(s): (if known)
Description of Suspect(s): (if name is unknown)
If incident happened to someone else, please provide their name(s): (if known)

What happened? Please describe the incident as clearly as possible.
Where did the incident occur?
List the names of any witnesses who were present: (if known)


If you are submitting a report and wish someone to follow-up with you please provide the contact information below. The information will be directed to the appropriate area and someone will respond to you regarding this report. If no information is provided, then the report data will be used for informational purposes only.
 

Yes, I would like someone from the appropriate office to contact me regarding this report.
If "Yes" please provide the following:      NOTE:
SafeWatch Reports are reviewed by the Dean of Students Office, M–F, 8 to 5. Reports submitted after hours will be reviewed promptly on the next workday following the submission of the report.
Name:
Phone:  
E-mail:

 

By submitting this form I hereby certify that the information I have provided in this report is true, correct, and complete to the best of my knowledge.