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Case Report Form

Please complete the form below following any meetings with individuals as part of your Dignity Contact role and contact the Report and Support Team for a debrief. Ensure you have informed the individual that the Case Report Form will be completed following the meeting.

This form is purely for data analysis purposes and only received by members of the Report and Support Team.

If you are looking for information or support on bullying and harassment and can't find what you need here, go to the Report and Support Team.


The Complainant
Staff/Student/other (required)
Did the complainant advise the concern was associated with any of the protected characteristics
What form did the harassment/bullying take
Does this incident involve C - Complainaint or P - Perpetrator
Is the accused perpetrator
Privacy notice
The data collected on this form is kept confidentially and only used to monitor the contact made to the Dignity Contacts.

The University of Warwick is the Data Controller of any information you have entered on this form and is committed to protecting the rights of individuals in line with Data Protection Legislation. The University's Data Protection webpages provide further information on your rights and how the University processes personal data. If you wish to submit a data subjects rights request, make a complaint or report a suspected personal data breach, please contact the University’s Data Protection Officer by email at

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