Learning Environment Report

Please do NOT use this report for the purposes of complaints of unlawful discrimination or harassment. These complaints should be filed as soon as possible with the Title IX coordinator, who may be reached at eotix@unr.edu, 775-784-1547, or the Title IX/EEOC office in the UNR Continuing Education Building, Room 206.

Please do NOT use this report for the purposes of concerns regarding barriers to the implementation of approved ADA accommodations of the need to request accommodations. These concerns should be filed as soon as possible with the UNR Disability Resource Center, William N. Pennington Student Achievement Center, Room 230, 775-784-6000.

Anonymity and Confidentiality

As a part of efforts to ensure you feel comfortable reporting professionalism lapses or mistreatment, Learning Environment Report Forms are anonymous unless the reporter includes his or her name; if that is the case, they are confidential. All possible measures will be used to protect the reporter from being identified, unless the reporter indicates this is not desired (for example, if a form is reporting exemplary professional behavior). Anonymous reports may not contain sufficient information to address the concern. Complete confidentiality cannot be guaranteed due to NSHE code and state and federal laws.

Purpose of the Learning Environment Report Form and Student Affairs and Personnel Committee

The Learning Environment Report Form provides a mechanism for students, residents, fellows, faculty and staff to report issues of professionalism in the learning environment to the Student Affairs and Personnel Committee. The purpose of the learning environment report is to enable UNR Med to respond promptly to any reports of mistreatment or unprofessional behavior and to also recognize exemplary behavior to ensure all members of the learning environment maintain professional standards. The Student Affairs and Personnel Committee is composed of the associate dean for student affairs, associate dean for curricular affairs, senior associate dean for undergraduate academic affairs, and the associate dean for graduate medical education. This committee meets and reviews every report which is submitted and forwards the report to the appropriate office to address the report. The Student Affairs and Personnel Committee confirms the concern was addressed.

Retaliation

We strive to ensure that everyone at UNR Med feels comfortable reporting professionalism lapses and student mistreatment. Please know that by filling out this form, your grade or evaluation will not be affected. Retaliation is prohibited and can be reported through this process.

If your report involves an individual on this committee, please select the option below to route the report to Dr. Timothy Baker.

Please check here to route to Dr. Baker:

False Accusations

Making and accusation which is intentionally false or is made with reckless disregard for the truth is prohibited and may be subject to discipline.

What Happens After a Report

After you submit your report, you will receive a report number. This number can be used to check the status of your report here , even if you submitted anonymously. In addition, if you include your name and email address in your submission, you will receive an email once steps have been taken to address this concern.

Emergencies

In an emergency, please call 911. This form is NOT for reporting emergencies and should only be used for professionalism or mistreatment reporting. If you do not feel safe, please dial 911, then call Dr. Singer.

Safety

If you feel unsafe in your current learning environment, you may leave and then contact Dr. Singer.

Your Contact Information

If you do not wish to disclose your name, please leave these items blank

Name

Email Address

Your Role

Are you reporting on behalf of someone else?

Incident

I wish to report:

Date of Incident

This incident took place in:

Please type in the name of the person(s) who is the focus of this submission. (Do not include those who happen to be nearby, but did not display exemplary or lapse in professional behavior).

Name of the Person

Person's Role

Add Person

Description of Incident

Please describe in the box below the circumstances and behavior that took place in the learning environment as well as the following: the position or role of individual(s) involved, your relationship to them, and the location where the behavior occurred.