Report Incident Please answer all relevant questions. Skip those that do not apply. Use tab to move between fields. Return will submit form. What company are you employed by? What location do you work at? What you would like to report? Where did the Incident Occur? When did the Incident Occur? How Did You Become Aware of the Violation? Did the incident occur more than once? yes no If so, how many times? Who targeted you? Why were you targeted? Was there management involvement? yes no If so, who? Was there anyone else involved? yes no If so, who? Was there any property damage? yes no If so, what? Has the incident been reported to anyone in supervision or management? yes no If so, who and when? Has the incident been reported to anyone outside the organization? yes no If so, who and when? Were there any witnesses? yes no If so, who? Do you wish to remain anonymous? yes no Would you be willing to assist further if asked yes no If yes, what email address can we communicate with you at? CONFIDENTIALITY COMMITMENT Lighthouse is a worldwide, anonymous reporting provider that will help your company identify improper behavior. We are committed to protecting the confidentiality and anonymity of employees who use our system. Our reporting system is protected from third party tampering and we have pledged to our client's employees that we will maintain the anonymity and confidentiality of our service. Please note that the information provided by you may be the basis of an internal and/or external investigation into the issue you are reporting and your anonymity will be protected to the extent possible by law. However, your identity may become known during the course of the investigation because of the information you have provided. Complaints are submitted by Lighthouse to your employer or employer's designee, and may or may not be investigated at the sole discretion of your employer.

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