Bias Incident Report

Please note: Making a report to BIRT is separate, and in addition, to the duty to report applicable to employees under CSU Executive Orders 1096 and 1097 (Revised March 29, 2019). If you are an Employee with a mandatory duty to report, or would like to file a complaint with the Civil Rights & Compliance Office please do so at crco@calpoly.edu.

Incident Details *

Date of Incident *

Month

Day

Year

Approximate Time *

Hour

Minute

Location *

Type of Incident *

To select more than one option press the Command key (⌘) on a Mac or Control (CTRL) key on a PC and make your selections.

Alleged Offender Information (if known):

Phone

Please Provide the Following Information if You Wish to be Contacted:

Phone

Document Upload

Upload documents or evidence related to the incident here.
Files must be less than 2 MB.
Allowed file types: jpg jpeg png pdf doc docx.

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Bias Incident Report

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