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Report an Incident
Incident Report Form
Items marked with a star
are required fields.
Your Reporting as:
Please specify your reporting mode
Survivor
Bystander/Whistle Blower
Bystander/Whistle Blower's Details
Your Name:
Telephone Number:
Anonymized if desired
Email Address:
Anonymized if desired
Your Location:
Please keep your report code safe and confidential. Sharing your report code with others may compromise the anonymity and confidentiality of your report.
Survivor's Details
Name of Survivor:
Category:
Student
Academic Staff
Administrative Staff
Support Staff
Visitor
Student/Staff Number
Telephone Number:
Anonymized if desired
Email Address:
Anonymized if desired
Place of Residence:
Incident Details
Date of Incident Occuring:
Time of Incident Occuring:
Type of Incident:
Select Category
Sexual Exploitation, Abuse, and Harassment(SEAH)
Physical Harm (PH)
Emotional Distress (ED)
Material Loss/Theft(ML)
Other forms of harm/risk (OH)
Please select the type that most represents the actual incident, allegation or risk that is being brought forward.
Description of Incident:
Please provide a narrative description of what happened including the location, date and time.
There will be an opportunity to peovide any related evidence/documents directly after you Submit
Incident Location:
Was the incident within Makerere University
Yes
No
Select Incident Location
Hostel
Lecture Room
University Canteen
University Hall
University Office
Via Phone Call/WhatsApp
Other Location
Witnesses:
Witnesses who can give information about the incident
Action Taken
Have you reported this incident anywhere?
Yes
No
Alleged Offender Details
Person Name:
Sex:
Select Sex
Female
Male
Not Known
Designation:
Select Designation
Academic Staff
Administrative Staff
Support Staff
Visitor
I don't know
Phone Number:
Do you know the alleged offernder's Telephone Number?
Yes
No
Email Address:
Do you know the alleged offender's Email Address?
Yes
No
College/Unit:
Is the alleged offender part of Makerere University community?
Yes
No
Select Unit
Office of Academic Registrar (AR)
College of Agricultural and Environmental Sciences (CAES)
College of Business and Management Sciences (CoBAMS)
College of Computing and Information Sciences (CoCIS)
College of Education and External Studies (CEES)
College of Engineering, Design, Art and Technology (CEDAT)
College of Health Sciences (CHS)
College of Humanities and Social Sciences (CHUSS)
College of Natural Sciences (CoNAS)
College of Veterinary Medicine, Animal Resource and Bio-Security (CoVAB)
Directorate of Gender Mainstreaming
Directorate of Estates
Directorate of Research and Graduate Training
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Makerere Institute of Social Research (MISR)
Makerere University Jinja Campus
Office of Dean of Students
Office of Director Legal Affairs
Office of DVC for Finance and Administration
Office of Director Estates and Works
Office of Director Human Resources
Office of Director ICT Support
Office of Director of Planning and Development
Office of Director Quality Assurance
Office of DVC for Academic Affairs
Office of University Bursar
Office of University Librarian
Office of University Secretary
Office of Vice Chancellor
School of Law
Other
Select the unit/college
