Below are all the questions included in the Anonymous Reporting Form. This shows all of the questions you may be asked, in the information below you will see the guidance of when this question is asked. At the top of each page there is a link to google translate.
The line reads: " If you need help to translate these questions, you can copy and paste the options into Google Translate."
Page 1
Thank you for choosing to report anonymously. We understand that this may be a difficult time for you.
Reminder: Please do not report patient safety concerns via Report and Support. This platform is for staff concerns only. All incidents involving a patient, near misses or concerns must still be reported through datix. This includes patient behaviour towards staff.
Choosing to report anonymously means we might not be able to help you directly but can help others. The information you give us today will help us to provide better support to others and inform prevention work across the RUH. However, reporting anonymously will not lead to formal action being taken.
If you decide to make an anonymous report, we will use the information for monitoring and reporting purposes only. We will not be able to act on your report.
Your report will be handled by staff in the People Hub. If you wish for your report to be supported by Freedom to Speak Up, please select 'yes' when asked.
You can read our Frequently Asked Questions or process flowchart if you require more information about how we process reports.
If you choose to report anonymously, we will retain the details of your report for statistical purposes and to identify trends and areas for improvement. We will process this information on the grounds of the RUH’s legitimate interests. If you would like to speak to someone, or need direct support or guidance, or would like a formal investigation to take place, please choose to report with contact details. Y
our data is important to us. We won't collect or store any information that goes against our privacy notice.
Page 2
2.1: Reporter role
The reporter must select exactly 1 option.
Prompts: The person I am reporting on behalf of is (required) (when "Incident happened to" has been answered with Happened to someone else) I am a: (required) (default).
Options:
Member of staff
Member of bank staff
Contractor
Locum or temporary staff
Student or trainee
Other – When ticked, a free-text box appears and must be completed.If other, please specify
2.2: Incident happened to
The reporter must select exactly 1 option.
I am reporting something which has: (required)
Options:
Happened to me
Happened to someone else
2.3: Team/department The reporter must select exactly 1 option.
I work in: (required)
Options:
Corporate Division
Chief Executive
Commercial and Strategic Development
Education
Finance
Human Resources [Directorate]
Information Technology
Nursing & Patient Care [Directorate]
Occupational Health
Patient Care Delivery
Staffing Solutions
Undergraduate Admin
Estates and Facilites
Catering
Cleaning
Facilities – Central
Logistics
Maintenance
Safety & Security
Sterilisation
Family and Specialist Services (FaSS)
Division Breast Unit [Directorate]
Cancer Services
FaSS Management
Fatigue Services
Gynaecology
Maternity Services
Oncology
Paed & NICU
Pharmacy [Directorate]
Sexual Health
Medical Division
Acute Medicine
Cardiology
Dermatology
Emergency Medicine
Endocrinology
Gastroenterology
Medical Physics
Medicine Management
Neurology
Older People’s Unit
Radiology
Respiratory
Rheumatology
Stroke
Therapy Services
Research and Development
Surgical Division
Anaesthesia
ENT
General Surgery
ITU Directorate
Ophthalmology
Oral, Mac-Fac & Orth
Pain Service
Pathology
Records & Bookings
Surgery Management
Theatres
Trauma & Orthopaedics
Urology
Other options
Other – When ticked, a free-text box appears and must be completed. If other, please specify
Prefer not to say
I don't know
Page 3
This page is only shown if "Incident happened to" has been answered with Happened to someone else.
3.1: Reporting on behalf of role The reporter must select exactly 1 option.
The person I am reporting on behalf of is a
Options:
Member of staff
Member of bank staff
Contractor
Locum or temporary staff
Student or trainee
Other – When ticked, a free-text box appears and must be completed.If other, please specify.
Page 4
4.1: Reported party role
The reporter must select exactly 1 option.
I think the person I am reporting is a: (required)
Options:
Member of staff
Member of bank staff
Contractor
Locum or temporary staff
Student or trainee
Other – When ticked, a free-text box appears and must be completed.If other, please specify.
Page 5
5.1: Reported party team The reporter must select exactly 1 option.
The person(s) I am reporting works in: (required)
Options:
Corporate Division
Chief Executive
Commercial and Strategic Development
Education
Finance
Human Resources [Directorate]
Information Technology
Nursing & Patient Care [Directorate]
Occupational Health
Patient Care Delivery
Staffing Solutions
Undergraduate Admin
Estates and Facilites
Catering
Cleaning
Facilities – Central
Logistics
Maintenance
Safety & Security
Sterilisation
Family and Specialist Services (FaSS)
Division Breast Unit [Directorate]
Cancer Services
FaSS Management
Fatigue Services
Gynaecology
Maternity Services
Oncology
Paed & NICU
Pharmacy [Directorate]
Sexual Health
Medical Division
Acute Medicine
Cardiology
Dermatology
Emergency Medicine
Endocrinology
Gastroenterology
Medical Physics
Medicine Management
Neurology
Older People’s Unit
Radiology
Respiratory
Rheumatology
Stroke
Therapy Services
Research and Development
Surgical Division
Anaesthesia
ENT
General Surgery
ITU Directorate
Ophthalmology
Oral, Mac-Fac & Orth
Pain Service
Pathology
Records & Bookings
Surgery Management
Theatres
Trauma & Orthopaedics
Urology
Other options
Other – When ticked, a free-text box appears and must be completed. If other, please specify
Prefer not to say
I don't know
Page 6
6.1: Incident Type
The reporter must select at least 1 option.
I would describe what happened as:
Select all that apply (required)
Options:
Cultural Concern
Pop-out definition (only when selected): In the context of the workplace, culture is the everyday behaviours, values and practices that are widely shared, respected and rewarded, regardless of their outcome. Broadly, culture is not behaviours that target individuals (this type of behaviour is more likely to be bullying, discrimination, or harassment), but instead is observed and experienced over time. Certain aspects of culture may have a disproportionately positive or negative impact on an individual or group of individuals, and there may not be an obvious reason for this.
Cultural concerns can range from regular social activities that exclude certain individuals, ‘banter’ or what is viewed as humour being derogatory, or the way that colleagues interact with one another feeling disrespectful.
Bullying
Pop-out definition (only when selected) Characterised as offensive, intimidating, malicious or insulting behaviour or an abuse of authority through means intended to undermine, humiliate, denigrate or injure the recipient.
Bullying and/or harassment may be by an individual against an individual, perhaps by someone in a position of authority such as a manager or supervisor, or involve groups of people. A manager may be bullied by a direct report. Bullying and/or harassment may be obvious or it may be insidious.
Whatever form bullying and/or harassment takes, it is unwarranted and unwelcome to the individual.
Discrimination
Pop-out definition (only when selected): Discrimination is where you have been treated differently just because of a protected characteristic (for example, age, disability, gender reassignment, race, religion or belief, sex, or sexual orientation).
It may result in, for example, not being selected to work on a particular project, not being promoted, or assumptions being made that you cannot do something because of your personal characteristics or situation.
Harassment
Pop-out definition (only when selected): Harassment is unwanted conduct related to a relevant protected characteristic, which has the purpose or effect of violating an individual’s dignity or creating an intimidating, hostile, degrading, humiliating or offensive environment for that individual’.
The relevant protected characteristics are age, disability, gender reassignment, race, religion or belief, sex and sexual orientation.
Harassment may be persistent or an isolated incident. The key element is that the actions or comments are viewed as demeaning and unacceptable to the recipient.
Sexual Harassment or Inappropriate Contact
Pop-out definition (only when selected): Sexual harassment refers to unwanted conduct or advances of a sexual nature, whether in person or online. It can include unwanted physical touching, leering, making sexual comments or jokes, posting sexual pictures online/ group chats or suggestions of benefits in return for sexual favours.
Inappropriate contact refers to unwanted physical or online contact that is often, though not always, sexual in nature.
Physical assault
Pop-out definition (only when selected): Physical assault is when an individual or a group attacks, or attempts to attack a person physically, or threatens to hurt that person. It can be with or without the use of a weapon, and can include scratching, pushing, kicking, punching, throwing things, or physically restraining another person.
Radicalisation, hate and extremism
Pop-out definition (only when selected): Radicalisation and extremism occur when someone starts to believe or engage with extreme views or hateful confrontational or violent language or behaviours in support of a political or social cause. It can be motivated by a range of factors, including ideologies, religious beliefs, political beliefs and prejudices against particular groups of people.
Other – When ticked, a free-text box appears and can optionally be completed.(optional)
Pop-out definition (only when selected): This covers things that don't feel right, or behaviour that you've noticed but doesn't quite fall into any of other categories
Page 7
7.1: Location
The reporter must select at least 1 option.
Where did the incident occur? (required)
Options:
In the community
Online (email/social media)
Online Teams meeting
On the RUH (Combe Park) Site
Riverside
Other – When ticked, a free-text box appears and must be completed. If other, please specify
Community Birthing Centre:
Chippenham
Frome
Paulton
Trowbridge
7.2: Incident Details - anon
The reporter must answer this question to continue.
This question is a multi-line free-text box.
Please tell us what has happened (required)
We understand that this section might be hard, but the more information you provide the more action we'll be able to take. Some of the things to think about are when and where it happened. If you provide names here, we may not be able to take any action if you wish to remain anonymous; but we can use your report to continue to inform our prevention work.
If you would prefer you can report with your contact details.
7.3: How often
The reporter must select exactly 1 option.
How often has this occurred? (required)
Options:
One off
Multiple occasions
Don’t know
7.4: Image
The reporter can optionally answer this question. This question asks for an image
I would like to upload an image related to what happened (optional)
This could be a screenshot or image of what happened
Page 8
8.1: Reported previously
The reporter must select at least 1 option.
Have you already reported the incident(s), or informed a member of staff? (required)
You can select multiple options
Options:
Yes: To my line manager / a senior leader
Yes: To HR
Yes: To a Union
Yes: To an external organisation
Yes: Other – When ticked, a free-text box appears and can optionally be completed.
No
Page 9
Freedom to Speak Up is an independent service to support staff when all other avenues of speaking up have been used.
All reports are handled by the People Hub Team. If you would prefer for your report to be supported by the Freedom to Speak Up Guardian select ‘Yes’, your report will be submitted to Freedom to Speak Up directly.
This means your report will not be handled by the People Hub Team and the first person to review your report is the Freedom to Speak Up Guardian. As it is anonymous they will not contact you, but will use your report to analyse themes and share information with the organisation.
9.1: FTSU Guardian
The reporter must select exactly 1 option.
Do you want your report to be supported by the Freedom to Speak Up Guardian? (required)
Options:
Yes
No
Page 10
10.1: Suspected factors
This question is optional, the reporter can select multiple options or none at all.
Do you feel that any of the following were motivating factors in what you are reporting? Select all that apply (optional)
Options:
Age
Pop-out definition (only when selected): A person belonging to a particular age (for example 32 year olds) or range of ages (for example 18 to 30 year olds)
Disability
Pop-out definition (only when selected): A person has a disability if she or he has a physical or mental impairment which has a substantial and long-term adverse effect on that person's ability to carry out normal day-to-day activities
Race/Ethnicity/Nationality
Pop-out definition (only when selected): A race is a group of people defined by their colour, nationality (including citizenship) ethnicity or national origins. A racial group can be made up of more than one distinct racial group, such as Black British.
Sex
Pop-out definition (only when selected): Sex discrimination is when you are treated differently because of your sex as a man or woman.
Having children
Having caring responsibilities
Pop-out definition (only when selected): Carers look after family members and friends requiring assistance due to illness, disability or other care and support needs. They may provide physical, medical or practical assistance and emotional support
Religion or belief
Pop-out definition (only when selected): Religion refers to any religion, including a lack of religion. Belief refers to any religious or philosophical belief and includes a lack of belief. Generally, a belief should affect your life choices or the way you live for it to be included in the definition.
Sexual orientation
Pop-out definition (only when selected): Whether a person's sexual attraction is towards their own sex, the opposite sex or to both sexes.
Socio-economic background
Pop-out definition (only when selected): Socio-economic background relates to a combination of an individual’s income, occupation and social background.
Trans-gender or non-binary identity
Pop-out definition (only when selected): Transgender, or trans, is an umbrella term for people whose gender identity is different from the sex assigned to them at birth. Non-binary is an identity embraced by some people who do not identify exclusively as a man or a woman.
Other – When ticked, a free-text box appears and can optionally be completed.(optional) None of the above
Page 11
11.1: Anonymous reason
This question is optional, the reporter can select multiple options or none at all.
We want everyone to feel safe to speak up and share their experiences. To help us learn more about how we can support you, if you feel comfortable saying, please tell us why you are disclosing anonymously: Please select all relevant reasons for you (optional)
Options:
I don’t know enough about the colleagues involved to report them
I don’t trust the process as I’ve reported a different incident in the past and nothing happened
I have previously faced detriment or I know someone who has faced detriment as a result of raising a concern
I’m worried I won’t be believed
I feel embarrassed or ashamed
I’m worried about the impact for me
I don’t want to get anyone in trouble
I’m worried about being called a trouble maker
I’m concerned it might impact my future career/studies
I don’t think I’ll be taken seriously
I don’t think its serious enough to report to HR
The person this happened to doesn’t want to report it themselves
I don’t want anyone to know what happened
I don’t want to go through a formal process
The person involved is in a position of authority
Prefer not to say
Page 12
This page is only shown if "Incident happened to" has been answered with Happened to me .
This question is optional, the reporter can select multiple options or none at all.
These questions help us to understand what is happening across our community. We want to make the RUH a safe and inclusive place to work. Understanding more about you is essential to help us to recognise patterns of behaviour towards groups of people and prevent similar incidents from happening to others.
Find out more about how your information helps.
12.1: Age group
How old are you?
Options: Your age is
16 – 20
21 – 30
31-40
41-50
51-65
66+
Prefer not to say
12.2: Gender
How do you define your gender?
Options: Your gender is
Man
Non-binary
Transgender Man
Transgender Woman
Woman
Other
Prefer not to say
12.3: Disability
Do you have a disability or long term health condition?
A disability can be an impairment, health condition or neurodiversity that has a substantial and long term impact on your ability to carry out normal day-to-day activities
Options: Do you have a disability?
Yes
No
Prefer not to say
12.4: Ethnic group
How would you describe your ethnic group?
Options:
Asian or Asian British (Includes any Asian background, for example, Bangladeshi, Chinese, Indian, Pakistani)
Asian or Asian British - Bangladeshi
Asian or Asian British - Chinese
Asian or Asian British - Indian
Asian or Asian British - Pakistani
Another Asian background – When ticked, a free-text box appears and can optionally be completed.(optional)
Black, African, Black British or Caribbean (Includes any Black background)
Black or Black British - African
Black or Black British - Caribbean
Another Black background – When ticked, a free-text box appears and can optionally be completed.(optional)
Mixed or multiple ethnic groups (Includes any Mixed background)
Mixed or multiple background - Asian and White
Mixed or multiple background - Black African and White
Mixed or multiple background - Black Caribbean and White
Another Mixed or Multiple background – When ticked, a free-text box appears and can optionally be completed.(optional)
White (Includes any White background)
White - British, Northern Irish, Scottish, Welsh
White - Irish
White - Irish Traveller or Gypsy
Another White background – When ticked, a free-text box appears and can optionally be completed.(optional)
Another ethnic group
Arab
Another ethnic group – When ticked, a free-text box appears and can optionally be completed.(optional)
Other options
Other – When ticked, a free-text box appears and can optionally be completed.(optional)
Prefer not to say
12.5: Faith/religion
Do you have a religion or belief?
Options: Your religion or belief?
None
Buddhist
Christian (including Catholic, Protestant or any other denomination)
Hindu
Jewish
Muslim
Sikh
Other – When ticked, a free-text box appears and can optionally be completed.(optional)
Prefer not to say
12.6: Sexual orientation
How do you define your sexual orientation?
Options: Your sexual orientation
Asexual
Bisexual
Gay man
Heterosexual
Lesbian/Gay woman
Pansexual
Other – When ticked, a free-text box appears and can optionally be completed.(optional)
Prefer not to say
Page 13
By submitting an anonymous form, you will not receive any contact regarding the report. If you would prefer to be contacted by a member of staff, please complete a report with contact details. Information already entered will be copied over to the new report.
Report with contact details, or continue by selecting the 'Send report' button below.
Thank You Page
Reporting can feel tough and we appreciate the time and effort you've taken to submit a report. It really does make a difference.
If you need immediate support here are some articles that might help.
Your case reference number: {{reportNumber}}
The line reads: " If you need help to translate these questions, you can copy and paste the options into Google Translate."
Page 1
Thank you for choosing to report anonymously. We understand that this may be a difficult time for you.
Reminder: Please do not report patient safety concerns via Report and Support. This platform is for staff concerns only. All incidents involving a patient, near misses or concerns must still be reported through datix. This includes patient behaviour towards staff.
Choosing to report anonymously means we might not be able to help you directly but can help others. The information you give us today will help us to provide better support to others and inform prevention work across the RUH. However, reporting anonymously will not lead to formal action being taken.
If you decide to make an anonymous report, we will use the information for monitoring and reporting purposes only. We will not be able to act on your report.
Your report will be handled by staff in the People Hub. If you wish for your report to be supported by Freedom to Speak Up, please select 'yes' when asked.
You can read our Frequently Asked Questions or process flowchart if you require more information about how we process reports.
If you choose to report anonymously, we will retain the details of your report for statistical purposes and to identify trends and areas for improvement. We will process this information on the grounds of the RUH’s legitimate interests. If you would like to speak to someone, or need direct support or guidance, or would like a formal investigation to take place, please choose to report with contact details. Y
our data is important to us. We won't collect or store any information that goes against our privacy notice.
Page 2
2.1: Reporter role
The reporter must select exactly 1 option.
Prompts: The person I am reporting on behalf of is (required) (when "Incident happened to" has been answered with Happened to someone else) I am a: (required) (default).
Options:
Member of staff
Member of bank staff
Contractor
Locum or temporary staff
Student or trainee
Other – When ticked, a free-text box appears and must be completed.If other, please specify
2.2: Incident happened to
The reporter must select exactly 1 option.
I am reporting something which has: (required)
Options:
Happened to me
Happened to someone else
2.3: Team/department The reporter must select exactly 1 option.
I work in: (required)
Options:
Corporate Division
Chief Executive
Commercial and Strategic Development
Education
Finance
Human Resources [Directorate]
Information Technology
Nursing & Patient Care [Directorate]
Occupational Health
Patient Care Delivery
Staffing Solutions
Undergraduate Admin
Estates and Facilites
Catering
Cleaning
Facilities – Central
Logistics
Maintenance
Safety & Security
Sterilisation
Family and Specialist Services (FaSS)
Division Breast Unit [Directorate]
Cancer Services
FaSS Management
Fatigue Services
Gynaecology
Maternity Services
Oncology
Paed & NICU
Pharmacy [Directorate]
Sexual Health
Medical Division
Acute Medicine
Cardiology
Dermatology
Emergency Medicine
Endocrinology
Gastroenterology
Medical Physics
Medicine Management
Neurology
Older People’s Unit
Radiology
Respiratory
Rheumatology
Stroke
Therapy Services
Research and Development
Surgical Division
Anaesthesia
ENT
General Surgery
ITU Directorate
Ophthalmology
Oral, Mac-Fac & Orth
Pain Service
Pathology
Records & Bookings
Surgery Management
Theatres
Trauma & Orthopaedics
Urology
Other options
Other – When ticked, a free-text box appears and must be completed. If other, please specify
Prefer not to say
I don't know
Page 3
This page is only shown if "Incident happened to" has been answered with Happened to someone else.
3.1: Reporting on behalf of role The reporter must select exactly 1 option.
The person I am reporting on behalf of is a
Options:
Member of staff
Member of bank staff
Contractor
Locum or temporary staff
Student or trainee
Other – When ticked, a free-text box appears and must be completed.If other, please specify.
Page 4
4.1: Reported party role
The reporter must select exactly 1 option.
I think the person I am reporting is a: (required)
Options:
Member of staff
Member of bank staff
Contractor
Locum or temporary staff
Student or trainee
Other – When ticked, a free-text box appears and must be completed.If other, please specify.
Page 5
5.1: Reported party team The reporter must select exactly 1 option.
The person(s) I am reporting works in: (required)
Options:
Corporate Division
Chief Executive
Commercial and Strategic Development
Education
Finance
Human Resources [Directorate]
Information Technology
Nursing & Patient Care [Directorate]
Occupational Health
Patient Care Delivery
Staffing Solutions
Undergraduate Admin
Estates and Facilites
Catering
Cleaning
Facilities – Central
Logistics
Maintenance
Safety & Security
Sterilisation
Family and Specialist Services (FaSS)
Division Breast Unit [Directorate]
Cancer Services
FaSS Management
Fatigue Services
Gynaecology
Maternity Services
Oncology
Paed & NICU
Pharmacy [Directorate]
Sexual Health
Medical Division
Acute Medicine
Cardiology
Dermatology
Emergency Medicine
Endocrinology
Gastroenterology
Medical Physics
Medicine Management
Neurology
Older People’s Unit
Radiology
Respiratory
Rheumatology
Stroke
Therapy Services
Research and Development
Surgical Division
Anaesthesia
ENT
General Surgery
ITU Directorate
Ophthalmology
Oral, Mac-Fac & Orth
Pain Service
Pathology
Records & Bookings
Surgery Management
Theatres
Trauma & Orthopaedics
Urology
Other options
Other – When ticked, a free-text box appears and must be completed. If other, please specify
Prefer not to say
I don't know
Page 6
6.1: Incident Type
The reporter must select at least 1 option.
I would describe what happened as:
Select all that apply (required)
Options:
Cultural Concern
Pop-out definition (only when selected): In the context of the workplace, culture is the everyday behaviours, values and practices that are widely shared, respected and rewarded, regardless of their outcome. Broadly, culture is not behaviours that target individuals (this type of behaviour is more likely to be bullying, discrimination, or harassment), but instead is observed and experienced over time. Certain aspects of culture may have a disproportionately positive or negative impact on an individual or group of individuals, and there may not be an obvious reason for this.
Cultural concerns can range from regular social activities that exclude certain individuals, ‘banter’ or what is viewed as humour being derogatory, or the way that colleagues interact with one another feeling disrespectful.
Bullying
Pop-out definition (only when selected) Characterised as offensive, intimidating, malicious or insulting behaviour or an abuse of authority through means intended to undermine, humiliate, denigrate or injure the recipient.
Bullying and/or harassment may be by an individual against an individual, perhaps by someone in a position of authority such as a manager or supervisor, or involve groups of people. A manager may be bullied by a direct report. Bullying and/or harassment may be obvious or it may be insidious.
Whatever form bullying and/or harassment takes, it is unwarranted and unwelcome to the individual.
Discrimination
Pop-out definition (only when selected): Discrimination is where you have been treated differently just because of a protected characteristic (for example, age, disability, gender reassignment, race, religion or belief, sex, or sexual orientation).
It may result in, for example, not being selected to work on a particular project, not being promoted, or assumptions being made that you cannot do something because of your personal characteristics or situation.
Harassment
Pop-out definition (only when selected): Harassment is unwanted conduct related to a relevant protected characteristic, which has the purpose or effect of violating an individual’s dignity or creating an intimidating, hostile, degrading, humiliating or offensive environment for that individual’.
The relevant protected characteristics are age, disability, gender reassignment, race, religion or belief, sex and sexual orientation.
Harassment may be persistent or an isolated incident. The key element is that the actions or comments are viewed as demeaning and unacceptable to the recipient.
Sexual Harassment or Inappropriate Contact
Pop-out definition (only when selected): Sexual harassment refers to unwanted conduct or advances of a sexual nature, whether in person or online. It can include unwanted physical touching, leering, making sexual comments or jokes, posting sexual pictures online/ group chats or suggestions of benefits in return for sexual favours.
Inappropriate contact refers to unwanted physical or online contact that is often, though not always, sexual in nature.
Physical assault
Pop-out definition (only when selected): Physical assault is when an individual or a group attacks, or attempts to attack a person physically, or threatens to hurt that person. It can be with or without the use of a weapon, and can include scratching, pushing, kicking, punching, throwing things, or physically restraining another person.
Radicalisation, hate and extremism
Pop-out definition (only when selected): Radicalisation and extremism occur when someone starts to believe or engage with extreme views or hateful confrontational or violent language or behaviours in support of a political or social cause. It can be motivated by a range of factors, including ideologies, religious beliefs, political beliefs and prejudices against particular groups of people.
Other – When ticked, a free-text box appears and can optionally be completed.(optional)
Pop-out definition (only when selected): This covers things that don't feel right, or behaviour that you've noticed but doesn't quite fall into any of other categories
Page 7
7.1: Location
The reporter must select at least 1 option.
Where did the incident occur? (required)
Options:
In the community
Online (email/social media)
Online Teams meeting
On the RUH (Combe Park) Site
Riverside
Other – When ticked, a free-text box appears and must be completed. If other, please specify
Community Birthing Centre:
Chippenham
Frome
Paulton
Trowbridge
7.2: Incident Details - anon
The reporter must answer this question to continue.
This question is a multi-line free-text box.
Please tell us what has happened (required)
We understand that this section might be hard, but the more information you provide the more action we'll be able to take. Some of the things to think about are when and where it happened. If you provide names here, we may not be able to take any action if you wish to remain anonymous; but we can use your report to continue to inform our prevention work.
If you would prefer you can report with your contact details.
7.3: How often
The reporter must select exactly 1 option.
How often has this occurred? (required)
Options:
One off
Multiple occasions
Don’t know
7.4: Image
The reporter can optionally answer this question. This question asks for an image
I would like to upload an image related to what happened (optional)
This could be a screenshot or image of what happened
Page 8
8.1: Reported previously
The reporter must select at least 1 option.
Have you already reported the incident(s), or informed a member of staff? (required)
You can select multiple options
Options:
Yes: To my line manager / a senior leader
Yes: To HR
Yes: To a Union
Yes: To an external organisation
Yes: Other – When ticked, a free-text box appears and can optionally be completed.
No
Page 9
Freedom to Speak Up is an independent service to support staff when all other avenues of speaking up have been used.
All reports are handled by the People Hub Team. If you would prefer for your report to be supported by the Freedom to Speak Up Guardian select ‘Yes’, your report will be submitted to Freedom to Speak Up directly.
This means your report will not be handled by the People Hub Team and the first person to review your report is the Freedom to Speak Up Guardian. As it is anonymous they will not contact you, but will use your report to analyse themes and share information with the organisation.
9.1: FTSU Guardian
The reporter must select exactly 1 option.
Do you want your report to be supported by the Freedom to Speak Up Guardian? (required)
Options:
Yes
No
Page 10
10.1: Suspected factors
This question is optional, the reporter can select multiple options or none at all.
Do you feel that any of the following were motivating factors in what you are reporting? Select all that apply (optional)
Options:
Age
Pop-out definition (only when selected): A person belonging to a particular age (for example 32 year olds) or range of ages (for example 18 to 30 year olds)
Disability
Pop-out definition (only when selected): A person has a disability if she or he has a physical or mental impairment which has a substantial and long-term adverse effect on that person's ability to carry out normal day-to-day activities
Race/Ethnicity/Nationality
Pop-out definition (only when selected): A race is a group of people defined by their colour, nationality (including citizenship) ethnicity or national origins. A racial group can be made up of more than one distinct racial group, such as Black British.
Sex
Pop-out definition (only when selected): Sex discrimination is when you are treated differently because of your sex as a man or woman.
Having children
Having caring responsibilities
Pop-out definition (only when selected): Carers look after family members and friends requiring assistance due to illness, disability or other care and support needs. They may provide physical, medical or practical assistance and emotional support
Religion or belief
Pop-out definition (only when selected): Religion refers to any religion, including a lack of religion. Belief refers to any religious or philosophical belief and includes a lack of belief. Generally, a belief should affect your life choices or the way you live for it to be included in the definition.
Sexual orientation
Pop-out definition (only when selected): Whether a person's sexual attraction is towards their own sex, the opposite sex or to both sexes.
Socio-economic background
Pop-out definition (only when selected): Socio-economic background relates to a combination of an individual’s income, occupation and social background.
Trans-gender or non-binary identity
Pop-out definition (only when selected): Transgender, or trans, is an umbrella term for people whose gender identity is different from the sex assigned to them at birth. Non-binary is an identity embraced by some people who do not identify exclusively as a man or a woman.
Other – When ticked, a free-text box appears and can optionally be completed.(optional) None of the above
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11.1: Anonymous reason
This question is optional, the reporter can select multiple options or none at all.
We want everyone to feel safe to speak up and share their experiences. To help us learn more about how we can support you, if you feel comfortable saying, please tell us why you are disclosing anonymously: Please select all relevant reasons for you (optional)
Options:
I don’t know enough about the colleagues involved to report them
I don’t trust the process as I’ve reported a different incident in the past and nothing happened
I have previously faced detriment or I know someone who has faced detriment as a result of raising a concern
I’m worried I won’t be believed
I feel embarrassed or ashamed
I’m worried about the impact for me
I don’t want to get anyone in trouble
I’m worried about being called a trouble maker
I’m concerned it might impact my future career/studies
I don’t think I’ll be taken seriously
I don’t think its serious enough to report to HR
The person this happened to doesn’t want to report it themselves
I don’t want anyone to know what happened
I don’t want to go through a formal process
The person involved is in a position of authority
Prefer not to say
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This page is only shown if "Incident happened to" has been answered with Happened to me .
This question is optional, the reporter can select multiple options or none at all.
These questions help us to understand what is happening across our community. We want to make the RUH a safe and inclusive place to work. Understanding more about you is essential to help us to recognise patterns of behaviour towards groups of people and prevent similar incidents from happening to others.
Find out more about how your information helps.
12.1: Age group
How old are you?
Options: Your age is
16 – 20
21 – 30
31-40
41-50
51-65
66+
Prefer not to say
12.2: Gender
How do you define your gender?
Options: Your gender is
Man
Non-binary
Transgender Man
Transgender Woman
Woman
Other
Prefer not to say
12.3: Disability
Do you have a disability or long term health condition?
A disability can be an impairment, health condition or neurodiversity that has a substantial and long term impact on your ability to carry out normal day-to-day activities
Options: Do you have a disability?
Yes
No
Prefer not to say
12.4: Ethnic group
How would you describe your ethnic group?
Options:
Asian or Asian British (Includes any Asian background, for example, Bangladeshi, Chinese, Indian, Pakistani)
Asian or Asian British - Bangladeshi
Asian or Asian British - Chinese
Asian or Asian British - Indian
Asian or Asian British - Pakistani
Another Asian background – When ticked, a free-text box appears and can optionally be completed.(optional)
Black, African, Black British or Caribbean (Includes any Black background)
Black or Black British - African
Black or Black British - Caribbean
Another Black background – When ticked, a free-text box appears and can optionally be completed.(optional)
Mixed or multiple ethnic groups (Includes any Mixed background)
Mixed or multiple background - Asian and White
Mixed or multiple background - Black African and White
Mixed or multiple background - Black Caribbean and White
Another Mixed or Multiple background – When ticked, a free-text box appears and can optionally be completed.(optional)
White (Includes any White background)
White - British, Northern Irish, Scottish, Welsh
White - Irish
White - Irish Traveller or Gypsy
Another White background – When ticked, a free-text box appears and can optionally be completed.(optional)
Another ethnic group
Arab
Another ethnic group – When ticked, a free-text box appears and can optionally be completed.(optional)
Other options
Other – When ticked, a free-text box appears and can optionally be completed.(optional)
Prefer not to say
12.5: Faith/religion
Do you have a religion or belief?
Options: Your religion or belief?
None
Buddhist
Christian (including Catholic, Protestant or any other denomination)
Hindu
Jewish
Muslim
Sikh
Other – When ticked, a free-text box appears and can optionally be completed.(optional)
Prefer not to say
12.6: Sexual orientation
How do you define your sexual orientation?
Options: Your sexual orientation
Asexual
Bisexual
Gay man
Heterosexual
Lesbian/Gay woman
Pansexual
Other – When ticked, a free-text box appears and can optionally be completed.(optional)
Prefer not to say
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By submitting an anonymous form, you will not receive any contact regarding the report. If you would prefer to be contacted by a member of staff, please complete a report with contact details. Information already entered will be copied over to the new report.
Report with contact details, or continue by selecting the 'Send report' button below.
Thank You Page
Reporting can feel tough and we appreciate the time and effort you've taken to submit a report. It really does make a difference.
If you need immediate support here are some articles that might help.
Your case reference number: {{reportNumber}}