Event Disclosure Form (Life Sciences)

Event Disclosure Form (Life Sciences)

This Disclosure Form is a confidential online tool that LMP learners can use to provide information regarding any behaviour experienced or witnessed that the learner perceives or suspects to be mistreatment. You have the option to submit this form anonymously (i.e. without the requirement that you provide your identity), with the understanding that doing so may make it more difficult for us to follow up with you to make sure you get support, to ensure that we have all the necessary details, and to report back to you regarding the status of your disclosure or its outcomes. It may also limit our ability to take action on the matter in certain cases. Note that you can submit an identified disclosure and tell us not to escalate the matter until we speak with you first and help you to understand all your options, including how we can protect your confidentiality.

This form is NOT FOR EMERGENCIES. If you are concerned about impending harm to yourself or others you should call 911 or seek immediate assistance from onsite security or other authorities. You should submit a form only after safety is ensured.

What will happen when this form is submitted: At your request, the designated Coordinator (or delegate, in their absence) will strive to contact you within 3 business days to initiate a discussion about possible next steps and supports.

Event Date, Location and Description
Did you

Did you Witness the mistreatment Experience the mistreatment
Date(s) that behaviour was witnessed/experienced
Location of event
Type of Behaviour

Please check all the types that you think apply. This is not mandatory to complete, but it can help us to track patterns of unprofessionalism and act accordingly
Mistreatment type

Mistreatment type Unprofessional behaviour Discrimination/Discriminatory harassment Sexual violence/sexual harassment Unsure Other Other
Description of the behaviour witnessed/experienced
Here are some questions that you can consider including in your disclosure report (there is no pressure to answer any or all of them, this is just a guide). -Who was responsible for the unprofessional behavior? -Who else was there as a witness? (please do not include names or identifiers) -What happened, to the best of your memory? -Where did this occur (including details of the course)? -When did this occur? Single event or recurring events? -How would you describe what you experienced? What was the impact on you? -Did you perceive the mistreatment to be attributed to your identification with a specific minority group? -Are there any other factors that you think would be helpful to record?
I prefer to speak in person with a designated coordinator, rather than providing a written account

I prefer to speak in person with a designated coordinator, rather than providing a written account Yes No
If you wish to provide a written account, please do so below.
Maximum of 1000 characters allowed. Currently Entered: 0 characters.
Who Should Receive the Form

LMP has leaders who are officially designated to receive and, if requested by you, discuss your submissions. If you would like to speak with a specific designated leader, please select from the list provided below. If you are unsure who to select or do not have a preference, please select the Vice Chair of Education, Life Sciences. Please note that a copy of all reports is sent to the Vice Chair of Education, Life Sciences, regardless of the leader selected, to ensure adequate supports, resources, and follow up.
Designated leader who you would like to receive this form

Designated leader who you would like to receive this form Witness the mistreatment Jeremy Mogridge Jeff Lee
If you have not heard back from the program leader you selected or the Vice Chair of Education, Life Sciences within 3 business days, they may be away. Please contact lmp.grad@utoronto.ca and they will direct you towards support and resources.
If you selected one of the designated Program leaders to discuss the behaviour experienced/witnessed, only those who need to be involved to review the matter, to respond, or are requested to provide personal support would be informed about your submission, and only with your consent. If you tell us that you want us to take action on your report but you do not wish to be named to the individual who is the source of mistreatment, we will try our best to facilitate this. There are circumstances where the LMP may need to breach confidentiality and take action urgently on a disclosure or report. This includes if there is an imminent risk to yourself or others, or sexual violence. We would discuss this with you in detail, including ways that we will work to support you.
Given the explanation above, do you wish to submit your account anonymously or share your identity.

Given the explanation above, do you wish to submit your account anonymously or share your identity. Anonymously Identified
If you wish to identify yourself, please indicate your name below.
Name Name First Last