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MDS student reporting
Please read the following information carefully before submitting a report through this form.
This reporting tool has been created to enable MDS students to report behaviour which they feel is inappropriate or makes them feel uncomfortable.
The College of Medical and Dental Sciences is opposed to all kinds discrimination and bullying within our student community, whether this occurs within our buildings, elsewhere on campus, while on placement, or in a social setting with other students. Reporting these incidents to us as they happen allows us to look into the matter whilst the situation is current and to seek early resolution.
Reports of incidents which happen whilst on placement will be passed on to appropriate placement providers. Please note that reports of incidents which take place within placement can only be accepted if they occurred in your capacity as a University of Birmingham student. Your personal details will not be passed on to an external placement provider without your permission. Once a report has been passed on, it will be up to each provider to follow their own procedures using the information provided.
If your report raises any concerns about another student's conduct or professionalism which may call their Fitness to Practise into question, you may be asked to provide further details and/or raise a
concern or complaint
to the University as appropriate; we will contact you if this is the case. If necessary, you can also report the incident to West Midlands Police by phone at 101.
This reporting tool will send your information to a mailbox, which is only accessible a select few staff who represent Student Services who will triage your report and forward it on to a member of staff from your programme. They will review your report and may contact you to provide more information if necessary, should an investigation take place. Your report will be transferred to a secure location on the University of Birmingham servers, and your contact details will not be stored unless they are required as part of an ongoing investigation.
Your report may be used alongside other reports to identify cultural issues within the College, University, and placement providers, which we can then work to address.
If you need help or support with completing this form, please email
mds-student-reporting@contacts.bham.ac.uk
and a member of the team will respond to you asap.
You can access wellbeing support through the University’s
Report + Support
service and/or by contacting a
Wellbeing Officer
within the College.
Note that FormDesk has been deemed to be compliant with all relevant data protection regulations, and any information which you submit through this form will be treated in the strictest confidence.
Name:
*
Email address (must end in bham.ac.uk):
*
Which of the following best describes your involvement in the incident which you are reporting?
*
<select an option>
I was the target
I was a witness
I was informed about the incident
Are you a student or a member of staff (reporting on behalf of a student)?
*
<Select an option>
Undergraduate student
Postgraduate taught student
Postgraduate research student
Member of staff
What course are you studying?
*
<select an option>
Biomedical Materials Science
Biomedical Science
Dental Hygiene and Therapy
Dental Surgery
Medicine and Surgery (including Graduate Entry)
Nursing
Pharmacy
Intercalated course
What course is the person/people who were the targets of this incident studying?
*
Biomedical Materials Science
Biomedical Science
Dental Hygiene and Therapy
Dental Surgery
Medicine and Surgery (including Graduate Entry)
Nursing
Pharmacy
Intercalated course
Postgraduate Taught course
Postgraduate Research course
Unsure
Where did the incident which you are reporting take place?
*
<select an option>
Medical School/IBR
Birmingham Dental Hospital
Other University of Birmingham location
Other NHS location
Other location
Where did the incident occur?
*
Which of the following best describes the nature of the incident(s) which you are reporting?
*
<select an option>
Bullying and/or harassment
Discrimination
Which of the following best describes the type(s) of discrimination which you are reporting?
*
Age
Disability
Gender identity
Race/ethnicity/nationality
Religion/faith/belief
Sex
Sexual orientation
Other
Who are you reporting?
*
NHS - patient
NHS - staff/contractor
UoB - student
UoB - staff/contractor
Other placement provider - service user
Other placement provider - staff
Other
Unknown
Is this a patient safety issue?
*
Yes
No
Unsure
Has the incident been reported to a member of staff at the placement?
*
Yes
No
Unsure
Please report this incident to a member of staff at your placement as a matter of priority.
Was the incident a one off, or is it ongoing behaviour?
*
One off
Ongoing
Unknown
If you can remember, please provide the date and time of the incident if it was a one off, or the date of the most recent incident if it is ongoing.
Please use the following free-text box to describe the incident.
Do not
include names, job titles, or any information that could be used to identify any individual. This information will be requested at a later stage if it is needed.
*
=
Input is required
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