This form is to document any safer spaces concerns that you have witnessed. Please fill it out if you wish a record be kept of it. You can enter as much or as little information as you wish. You may be anonymous or leave your name; whichever makes you more comfortable.

* 1. Date:

* 2. Nature of concern:

* 3. Did anyone speak up or otherwise address this concern?

* 4. How did it make you feel?

* 5. Do you wish for any follow up from this concern?

* 6. Are you interested in making an official complaint?

* 7. Do you wish to be contacted about this concern?

* 8. If yes, please leave your preferred mode of communication, whether that be e-mail, phone number, or something else:

Thank you for sharing your safer spaces concern with us. At any point, feel free to send e-mails to or to, or to speak to any of the collective coordinators or the safer spaces coordinator in person. Their office hours are posted in the Centre as well as on the website.