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You are currently in EthicsPoint, the secure reporting system of NAVEX, to report a concern or suspicion of harassment, abuse, or exploitation, including sexual misconduct and trafficking in persons.

EthicsPoint is NOT an Emergency Service

If an immediate threat to life exists or if emergency assistance is needed, please contact your local authorities and/or alert local senior management and country or regional Safety and Security Advisor at once.

CRS is committed to assessing and addressing all reports. The information you provide here will be used by CRS’ Ethics Unit Safeguarding Team and relevant senior management to determine appropriate next steps. Please fill in as much information as is known. Detailed information enables CRS to thoroughly assess and address the reported concern. If details are unknown, do not attempt to assess or investigate the concern. Fill in the information that is known to you. It is better to report early with fewer details than wait to report or not report at all.

CRS’ Ethics Unit Safeguarding Team will confirm receipt of your report within two to three days and thereafter may need to follow up with you to obtain further details. If you are reporting anonymously, the Ethics Unit Safeguarding Team will contact you though this system. Please use your report key and password to return to EthicsPoint through the website periodically to see if CRS has any questions regarding your report.

Items marked with a diamond ♦ are required fields.

Reporter Details

Reporter Details	♦ Do you want to remain anonymous? Yes No If you choose to remain anonymous, CRS may follow up with you using this reporting system. Please use your report key and password to return to EthicsPoint periodically. Your Name & Contact Information ♦ First Name ♦ Last Name ♦ Phone Number Include the area code or country code. ♦ Email (Format: username@domain.com) Gender ♦ Relationship to Catholic Relief Services ♦ Name of Organization ♦ Job Title ♦ How did you become aware of this concern, suspicion, or incident? If told to you by another person, please share the identity of who told you, their relationship to CRS and how they are aware of the incident. If “other”, please describe

♦

Do you want to remain anonymous?

Yes No

If you choose to remain anonymous, CRS may follow up with you using this reporting system. Please use your report key and password to return to EthicsPoint periodically.

Your Name & Contact Information

♦

First Name

♦

Last Name

♦

Phone Number

Include the area code or country code.

♦

(Format: username@domain.com)

Gender

♦

Relationship to Catholic Relief Services

♦

Name of Organization

♦

Job Title

♦

How did you become aware of this concern, suspicion, or incident?

If told to you by another person, please share the identity of who told you, their relationship to CRS and how they are aware of the incident.

If “other”, please describe

Description of Concern or Suspicion

Type of Incident	♦ Please describe the concern, suspicion, or incident Please provide as many details as are known about what took place, from start to finish. Describe concerning behaviors (ex. touching or other physical contact, display of inappropriate images, name-calling) and statements (ex. language used).

Location	♦ Country Additional details about location of incident Examples include: CRS Office Location, Name of Village/Town/City. If multiple locations, please include all locations that are known.

Dates	♦ Approximate Date of Incident (Format: mm/dd/yyyy) If ongoing or multiple incidents, please select the approximate date of the first incident. If this has happened more than once, how long has this problem been going on?

Details	♦ At the time of this report, is anyone involved in or affected by these concerns in imminent danger? Yes No Do Not Know If answering yes, please contact your local authorities and/or alert local senior management and country or regional Safety and Security Advisor at once ♦ If yes, indicate who is in danger and describe the nature of the danger/risk Examples include: reporter, victim/survivor, witness, perpetrator/subject of complaint ♦ Has CRS or any other organization/actor already taken action in relation to this concern, suspicion, or incident? Yes No Do Not Know Examples include: Relocated person/s involved, notified local authorities or other relevant entity ♦ If yes, please describe the action that has already been taken, including approximate date/s of action

Details

♦

At the time of this report, is anyone involved in or affected by these concerns in imminent danger?

Yes No Do Not Know

If answering yes, please contact your local authorities and/or alert local senior management and country or regional Safety and Security Advisor at once

♦

If yes, indicate who is in danger and describe the nature of the danger/risk

Examples include: reporter, victim/survivor, witness, perpetrator/subject of complaint

♦

Has CRS or any other organization/actor already taken action in relation to this concern, suspicion, or incident?

Yes No Do Not Know

Examples include: Relocated person/s involved, notified local authorities or other relevant entity

♦

If yes, please describe the action that has already been taken, including approximate date/s of action

Victim/Survivor Details

Victim	Victim Identity ♦ First Name If you are unable to provide this information, please type “Unknown” ♦ Last Name If you are unable to provide this information, please type “Unknown” Phone Number Include the area code or country code. Email (Format: username@domain.com) (If you are unable to provide the victim's identity enter Unknown into those fields.) Gender ♦ Relationship to Catholic Relief Services ♦ Approximate Age If the victim/survivor is under age 18, please provide name and contact information for parent/caregiver/guardian (if known) Please provide any further details that are known about the victim/survivor Examples include: gender, disability status, unique vulnerabilities, current location, job title, physical and emotional state (ie. cuts, bruises, behavior changes), known support needs (ie. psychosocial, medical) Please list any support services already offered/provided to the victim/survivor in connection to the reported incident/s Examples include: medical, psycho-social, legal or other assistance ♦ Is there more than one victim/survivor? Yes No

Victim

Victim Identity

♦

First Name

If you are unable to provide this information, please type “Unknown”

♦

Last Name

If you are unable to provide this information, please type “Unknown”

Phone Number

Include the area code or country code.

(Format: username@domain.com)

(If you are unable to provide the victim's identity enter Unknown into those fields.)

Gender

♦

Relationship to Catholic Relief Services

♦

Approximate Age

If the victim/survivor is under age 18, please provide name and contact information for parent/caregiver/guardian (if known)

Please provide any further details that are known about the victim/survivor

Examples include: gender, disability status, unique vulnerabilities, current location, job title, physical and emotional state (ie. cuts, bruises, behavior changes), known support needs (ie. psychosocial, medical)

Please list any support services already offered/provided to the victim/survivor in connection to the reported incident/s

Examples include: medical, psycho-social, legal or other assistance

♦

Is there more than one victim/survivor?

Yes No

Perpetrator/Subject of Complaint Details

Suspect	♦ First Name ♦ Last Name (If you are unable to provide the suspect's identity enter Unknown into those fields.) Phone Number Include the area code or country code. Email (Format: username@domain.com) Gender ♦ Relationship to Catholic Relief Services Please provide any further details that are known about the perpetrator/subject of complaint Examples include: gender, disability status, current location, job title ♦ Is there another perpetrator/subject of complaint? Yes No

Suspect

♦

First Name

♦

Last Name

(If you are unable to provide the suspect's identity enter Unknown into those fields.)

Phone Number

Include the area code or country code.

(Format: username@domain.com)

Gender

♦

Relationship to Catholic Relief Services

Please provide any further details that are known about the perpetrator/subject of complaint

Examples include: gender, disability status, current location, job title

♦

Is there another perpetrator/subject of complaint?

Yes No

Other Witnesses/Persons of Knowledge Details

Other Witnesses/Persons of Knowledge Details	♦ Is anyone else aware of this concern, suspicion, or incident? Yes No

Supporting Documentation

Supporting Documentation	If you have a document or file that supports your report, most common file types can be uploaded: Select a file File Description Attached Files: Files Uploaded: Space Remaining: Max File Size: Errors:

Create a Password to Follow-up on this Report

	Provide a password for this report in the space below. Upon submission of this report, you will be issued a 'report key'. Please write down your chosen password and report key and keep in a safe place – neither your report key or password can be recovered if you misplace them. Using the report key and password you will be able to use the "Follow Up" functionality of this report which will allow you to: Upload documents Respond to follow-up questions/comments Provide additional information

Provide a password for this report in the space below. Upon submission of this report, you will be issued a 'report key'. Please write down your chosen password and report key and keep in a safe place – neither your report key or password can be recovered if you misplace them. Using the report key and password you will be able to use the "Follow Up" functionality of this report which will allow you to:

Upload documents
Respond to follow-up questions/comments
Provide additional information

Password	♦Password ♦ Re-Enter Password (Passwords must be at least four(4) characters in length.)

Safeguarding Report

Sub-Title and/or Tag Line

EthicsPoint is NOT an Emergency Service

Reporter Details

Your Name & Contact Information

Description of Concern or Suspicion

Victim/Survivor Details

Victim Identity

Perpetrator/Subject of Complaint Details

Other Witnesses/Persons of Knowledge Details

Supporting Documentation

Create a Password to Follow-up on this Report