Mistreatment/Unethical/Unprofessional Behavior Report

Please provide as much information as possible:
(your identity will remain anonymous unless you choose to provide contact information below)

Phase/Year: *

Course/Clerkship: *

Campus: *

Location: *

Name (optional):

Email address (optional):

If you experienced or witnessed mistreatment based on gender, race, ethnicity, religion, or sexual orientation:

1. Please describe the incident:

2. Who was involved (i.e. Residents, Attendings, Medical Students, Other Health Care Professionals)? Names of individuals are not necessary:

3. Was this incident reported, and if so, to whom?:

4. If known, what was the outcome of the report?:

If you experienced or witnessed unethical or unprofessional behavior or mistreatment other than described above:

5. If you experienced or witnessed unethical or unprofessional behavior or mistreatment other than described above, or observed conditions that might have an adverse effect on patient safety, please describe the incident:

6. Who was involved (i.e. Residents, Attendings, Medical Students, Other Health Care Professionals)? Names of individuals are not necessary.:

7. Was this incident reported, and if so, to whom?:

8. If known, what was the outcome of the report?:

If you would like to upload a photo(s) to accompany your report, please check this box to proceed (optional):

If you want to upload a photo(s) to accompany your report anonymously, please follow these steps.

Step 1: Copy the SharePoint URL below.
Step 2: Open an Incognito/InPrivate browser window and paste the URL.
Step 3: Click the Select Files button and attach your photo or supporting document.
Step 4: Enter any text character in the name text fields. (i.e. *, $, ABC) to maintain your anonymity.
SharePoint Last and First Name entry fields

SharePoint Last and First Name entry fields

Step 5: Click the Upload button
https://drexel0-my.sharepoint.com/:f:/g/personal/sb3427_drexel_edu/EoyZLCBxAQhHg5N--s-CaR0BACtd7YMX8VaQnYbVzlXUsw

Otherwise, click the link below to upload a photo from your named account:

Unprofessionalism Portal Report Photo Upload