Concern & Incident Reporting Form

Rancho Cielo is committed to maintaining a safe, respectful, and ethical environment for all employees and students. This form allows anyone within the Rancho Cielo community to report any concern, violation, or situation that may not align with our values, policies, or standards of conduct. This includes but is not limited to issues related to safety, ethics, workplace or campus behavior, or any other matter that may affect our environment.

All employees and students can make reports. You may choose to submit this form anonymously if you do not wish to share your name. Submissions will be reviewed by Human Resources and/or the appropriate administrative office.

This online reporting form is intended to supplement, and does not replace, Rancho Cielo’s other reporting or complaint procedures, including procedures for reporting alleged discrimination, harassment, or retaliation. Individuals who wish to report perceived discrimination, harassment, or retaliation may use this form and/or the procedures outlined in the employee or student handbook.  Individuals with questions about the scope of purpose of this online reporting form may contact Rancho Cielo’s Human Resources Department.

Confidentiality and Non-Retaliation

Rancho Cielo will make every effort to protect the confidentiality of individuals who submit reports in good faith. Retaliation against anyone who raises a concern or participates in an investigation is strictly prohibited.

Rancho Cielo may need to disclose information obtained through this form, including but not limited to its obligations to investigate workplace allegations and comply with applicable mandated reporting laws.

1. Reporter Information

You may leave this section blank if you wish to remain anonymous.

Full Name:

(optional)

Role:

Employee

Student (18+)

Student (under 18)

Department/Program:

(if applicable)

Preferred Contact Method:

(optional)

Email

Phone

Other

Contact Information:

(optional)

2. Type of Concern (check all that apply)

Concern

General workplace or classroom concern

Conduct inconsistent with Rancho Cielo policies or values

Safety or security issue

Ethical concern or misuse of resources

Violation of policy, rule, or procedure

Other

Please Describe:

3. Description of the Concern

Please describe the concern or incident in as much detail as possible:

– What happened?

– Who was involved?

– When and where did this occur?

– Were there any witnesses?

Details:

4. Supporting Information (optional)

Attach or describe any supporting materials:

(emails, screenshots, photos, documents, etc.)

Drop files here or Select files

Accepted file types: jpg, png, pdf, Max. file size: 3 MB.

5. Has this concern been shared with anyone else?

Has this concern been shared with anyone else?

Yes

No

Please Specify Who:

6. Desired Outcome (optional)

What would you like Rancho Cielo to do in response to this concern?

7. Acknowledgment

Good Faith Consent

I am submitting this concern in good faith and to the best of my knowledge, the information provided is accurate.

Report will be reviewed by Rancho Cielo Human Resources Consent

I understand that this report will be reviewed by Rancho Cielo Human Resources and/or the appropriate department.

Signature:

(optional)

Date

Month

Day

Year

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