Community Safety & Incident Report Form

Confidentiality Notice: The Church of Body Modification is committed to maintaining a safe and respectful community. This form is for reporting violations of our Member Code of Conduct, including harassment, violations of consent, hate speech, or safety concerns.

Who sees this report? This report is seen by the Safety Committee which includes Chris Carter, Jolene Robinson, and Arrow Minor. Your identity and the details of this report will be kept strictly confidential and will not be shared with the person you are reporting without your explicit consent, unless required by law.

Reporter Information While you may submit this form anonymously, please note that doing so may limit our ability to investigate or follow up with you regarding the outcome.

Your Name

Your Email

Best Way to Contact You *--- Select Choice ---EmailPhoneDo Not Contact MeOther

Be sure to include contact information in description below.

Name of the person(s) you are reporting: *

the reporting: person(s)

Date of Incident: *

Location of Incident: *--- Select Choice ---Official Discord ServerFacebook PageIn-Person Event / MeetupPrivate Direct Message (DM)Other

Nature of the Violation: *

• Harassment or Bullying
• Violation of Consent / Bodily Autonomy
• Hate Speech / Discrimination
• Sharing Private Content (Doxxing/Outing)
• Unwanted Sexual Attention
• Other

Description of the Incident: *

Please provide as much detail as possible. What was said or done? What was the context?

Additional Information:

To share images, use an anonymous image site like https://postimages.org/ and share the URL here.

Desired Outcome: *

What would you like to see happen as a result of this report? (e.g., No contact order, formal warning, removal from community, just wanted it on record)

Submit