The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

Za4U3Avv2R7nKW3coPG6XyvCUtxTaPmIEXN82Cwy9sRhjum7B6Rf2m2h5j4ATMFGtjrUd

Report an Incident of Bias at
UW Medicine/UW School of Medicine

Date report opened

M-D-Y

UW Medicine is an organization that embraces diversity, advances equity, and fosters inclusion and collaboration.
The Bias Reporting Tool is for sharing incidents of bias including racism, sexism, ableism, discrimination of any form or other behaviors that do not reflect the prioritization of equity expected in all areas of our community.
We are committed to responding to these events and continuing to improve our climate.
Thank you for taking the time to tell us what happened.

What can I report?

The BRT is for non-emergency incidents only.

FOR EMERGENCIES DIAL 911
To report criminal activity to the UW Police:

Non-emergency: 206-685-8937

Anonymous Tips: 206-685-8477

Who can report?

Any staff, student, trainee, or faculty member of UW Medicine.

Patients
If you are a patient, contact Patient Relations by clicking here. Please do not submit a report in the BRT.

For staff, students, trainees, or faculty: if the event is related to patient care, please do not include patient identifiers in the report. If you think a specific patient was adversely impacted, please consider submitting a PSN.

When you share a report...

Please include observations and factual descriptions as much as possible.

If you choose to report anonymously, please know our ability for follow up will be limited.

Important Reminders

As with all emails, tools, or reports - information you share in this report may be subject to public records requests. Information shared may be subject to release under federal and state law.

The BRT Committee is neither a formal investigative nor an oversight body.

Please share your name:

I prefer to not share my name, and prefer to make an anonymous report.

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Thank you for your report. This is a reminder that by reporting anonymously, our ability to support you is limited.
If possible, we encourage you to provide your name so we can hear more about what happened and connect you to resources. If you do report anonymously, the information will be tracked for potential recommendations.
Thank you again for taking the time to submit a report.

Short name of reporter

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On whose behalf are you filing this report?

* must provide value

I am filing this report on behalf of myself.

I am filing this report on behalf of someone else who is aware that I am doing so.

I am filing this report on behalf of someone else who is not aware that I am doing so.

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Who was primarily affected by the biased behavior?

* must provide value

Faculty

Patient/caregiver

Staff

Student

Trainee

Visitor

Other

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Who engaged in the biased behavior?

* must provide value

Faculty

Patient/caregiver

Staff

Student

Trainee

Visitor

other

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Please provide the name(s) of those involved in the event, if available

Please do not include patient identifiable information (such as name, date of birth, or medical record number) in your report.

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Please list all of the dates that you are aware of on which this behavior occurred. If this is a repeated event, please select the most recent date.

Date of Incident

M-D-Y

What type of bias incident occurred? Please check all that apply.

Bullying

Discrimination

Flyers/ Graffiti

Harassment

Intimidation/ Threat

Microaggression

Retaliation

Verbal Assault

Unsure of Category

Other

What identity(s) was/ were the target of bias in this incident? Please check all that apply.

* must provide value

Ability/ disability

Age

Caregiver status

Ethnicity

Gender

Gender identity

Housing status

Job class/ discipline (e.g., physician, nurse, medical assistant)

Language

Race

Religion

Sexual Orientation

Size

Socioeconomic status/ class

Substance Use

Veteran status

Other

Location of incident.
Please be as specific as possible and include the facility name (such as Montlake, HMC, Primary Care Clinic, NW, etc)

* must provide value

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Short name of location

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Please provide a description of the incident.

Please do not include patient identifiable information (such as name, date of birth, or medical record number) in your report.

* must provide value

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Summary

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May we contact you?

* must provide value

Yes

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Thank you for your report. This is a reminder that by reporting anonymously, our ability to support you is limited.
If possible, we encourage you to provide your email address so we can hear more about what happened and connect you to resources. If you do report anonymously, the information will be tracked for potential recommendations.
Thank you again for taking the time to submit a report.

Please provide your email address.

* must provide value