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COMMONWEALTH OF PENNSYLVANIA SEXUAL MISCONDUCT/ABUSE DISCLOSURE RELEASE (under Act 168 of 2014) (Hiring school entity or independent contractor submits this form to ALL current employer(s) and to

How to fill out sexual misconductabuse disclosure form

How to fill out a sexual misconduct/abuse disclosure form:

1. Provide your personal information: Start by filling out your full name, contact information (address, phone number, email), and any identification numbers or other relevant details requested on the form.
2. Describe the incident: Clearly and accurately explain the details of the sexual misconduct or abuse that occurred. Include the date, time, and location of the incident, as well as any other pertinent information that will help investigators understand what happened.
3. Identify the perpetrator(s): If possible and known, provide the name(s) or any other identifying information about the person(s) who committed the misconduct or abuse. Include their relationship to you, if applicable (e.g., supervisor, colleague, acquaintance).
4. Provide supporting evidence: If you have any relevant documents, photographs, videos, or other evidence that supports your disclosure, attach or submit them along with the form. These pieces of evidence can include text messages, emails, witnesses' statements, or any other proof that can validate your claim.
5. Choose confidentiality or anonymity: Decide if you wish to keep your identity confidential or if you prefer to remain anonymous throughout the investigation process. Some forms may have specific sections to indicate your preference.
6. Sign and date the form: After completing all the required sections, read through the form carefully, ensuring that all the information provided is accurate and truthful. Sign and date the form in the designated area to certify your disclosure.
7. Seek additional support: Remember to reach out for any necessary support during this time. Contacting a counselor, therapist, or support hotline can be beneficial in dealing with any associated emotional or psychological effects of the incident.

Who needs a sexual misconduct/abuse disclosure form?

Anyone who has experienced sexual misconduct or abuse and wishes to report it should utilize a sexual misconduct/abuse disclosure form. It is typically necessary for victims or witnesses to complete this form so that the incident can be formally documented and investigated by the relevant authorities, such as human resources departments, law enforcement agencies, or educational institutions. The form helps gather essential information about the incident, the victim, and the alleged perpetrator, ensuring that appropriate action can be taken to address and prevent further misconduct or abuse.

For pdfFiller’s FAQs

What is sexual misconduct/abuse disclosure form?

The sexual misconduct/abuse disclosure form is a document used to report incidents of sexual misconduct or abuse.

Who is required to file sexual misconduct/abuse disclosure form?

Anyone who has witnessed or experienced sexual misconduct or abuse is required to file the disclosure form.

How to fill out sexual misconduct/abuse disclosure form?

To fill out the form, you must provide detailed information about the incident, including dates, times, locations, and persons involved.

What is the purpose of sexual misconduct/abuse disclosure form?

The purpose of the form is to report incidents of sexual misconduct or abuse in order to address and prevent further occurrences.

What information must be reported on sexual misconduct/abuse disclosure form?

Information such as dates, times, locations, description of the incident, and names of persons involved must be reported on the form.

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