Submit a Report

This Title IX Report documents incidents or alleged violations of rape, sexual assault, partner violence, stalking, harassment, or sexual discrimination. This form can be utilized by anyone from the OHSU community wishing to file a report on their own behalf or by anyone wishing to file a report on behalf of an OHSU community member. Please note that submissions using this form are not reviewed outside of normal business hours. If you are in immediate crisis, call 911 or 503-494-4444.

Please note the following definitions used in the form:

Complainant: The person who submits the report. The complainant may be the victim, a witness or another person who knows about an incident or situation.
Victim/Survivor: The person who experienced the violation or harm.
Respondent: The person accused of perpetrating the violation or harm. If there are more than 2 respondents, please note that in the description of events.
Witness: a person who saw or heard an incident occur or who has relevant information about it.

Your full name (You may enter "Anonymous"):

Your position/title:

Phone Number:

Email Address:

Type of Incident:

If "Other" was selected, please explain:

Complainant Status at OHSU:

Date(s) that the Incident Took Place (May enter "Unknown"):

Time that the Incident Took Place:

Location of Incident:

Specific Location:

Do you have reason to believe this incident represents a present threat of harm or danger to the Complainant or other member(s) of the community:

Yes

Briefly describe relationship of the Complainant to the Respondent:

Was a weapon involved?:

Yes

If a single Respondent, as best as you are able, please describe the person's race, gender, age, height, and weight:

Please provide a narrative of the incident. Be sure to provide as much information as possible about the incident: