Respectful Public Behaviour Incident Form

At the City of Welland, we're committed to dignity and safety. We believe that every individual deserves to feel safe and respected in our community spaces. We're dedicated to fostering an environment where dignity is upheld, and all forms of violence, vandalism, and inappropriate behaviour are prohibited.

The Respectful Public Behaviour policy outlines clear expectations and responsibilities for employees, volunteers, user groups, and visitors to help us maintain a positive atmosphere across our programs and facilities. By promoting awareness and understanding of these standards, we aim to create a supportive community where everyone can thrive. Join us in our commitment to respect and safety for all.

Individual reporting details

First name

Last name

Department

Position

Complainant's Email

Incident information

Date incident occurred

Time incident occurred

Incident location

Please describe the incident.

Participant(s) involved

Complainant's name

Phone number

Address

City

Postal code

Email

Respondent's name

Phone number

Address

City

Postal code

Email

Category (please check all that apply)

Verbal assault

Use of drugs or alcohol

Vandalism

Possession of weapon

Physical assault or harm

Theft of property

Threats

Harassment or bullying

Other

Please describe in detail what happened.

Police information (if applicable)

Police called

Yes

No

Did another individual witness the incident?

First witness

Name

Phone

Address, city, postal code

Email

Position

Second witness

Name

Phone

Address, city, postal code

Email

Position

Who else was made aware of the incident?

First individual

Name

Phone

Address, city, postal code

Email

Date informed

How were they informed?

In-person

Telephone

Email

Other

Second individual

Name

Phone

Address, city, postal code

Email

Date informed

How were they informed?

In-person

Telephone

Email

Other

Third individual

Name

Phone

Address, city, postal code

Email

Date informed

How were they informed?

In-person

Telephone

Email

Other

Before you click the submit button

Please make sure your contact information is correct.