Misconduct Form

These forms can be used by anyone to alert CHMK Leaders of volunteer and staff misconduct. If you have been the target of improper behavior or have witnessed improper behavior directed toward someone, please answer the following questions:

- Was the behavior carried out on purpose?

- Was the behavior intended to cause harm? (Harm may be physical, verbal, relational, social, emotional, and/or via electronic communication)

- Have there been repeated and/or widespread acts of this behavior?

Complaints against camp leadership should be submitted to the Executive Director. Complaints against the Executive Director should be submitted to the CHMK Foundation Board. All reports will be investigated and disciplinary action will be taken as warranted.

Staff/volunteers have the right to complete this form anonymously. However, it will be easier for the foundation to investigate this matter if as much information as possible is provided. Submission of a good faith complaint or report of improper behavior, bullying, or harassment will not affect the person reporting the behavior or the reporter’s future employment or working environment. A reporter that knowingly falsely accuses someone will be subject to disciplinary action.

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* 1. Name

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* 2. Email

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* 3. Please select one of the following. You are a:

Field Staff

Medical Staff

Volunteer

Other (please specify)

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* 4. Date(s) of alleged misconduct

Date / Time

Date

Time

AM/PM

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* 5. Name of staff/volunteer(s) subjected to misconduct:

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* 6. Person(s) alleged to have committed the misconduct:

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* 7. Location where the incident took place:

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* 8. Summarize the incident(s) or occurrence(s) of misconduct as accurately as possible.

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* 9. Names of Witnesses:

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* 10. Have you reported this to anyone else?

Yes

Misconduct Form

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* 1. Name

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* 2. Email

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* 3. Please select one of the following. You are a:

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* 4. Date(s) of alleged misconduct

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* 5. Name of staff/volunteer(s) subjected to misconduct:

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* 6. Person(s) alleged to have committed the misconduct:

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* 7. Location where the incident took place:

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* 8. Summarize the incident(s) or occurrence(s) of misconduct as accurately as possible.

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* 9. Names of Witnesses:

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* 10. Have you reported this to anyone else?

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* 11. If you answered "yes" to the question above, to whom have you reported this incident?

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* 12. Additional Information To Provide Clarity or Insight To The Incident