Reference · stays inside this course
Appendix C — Incident documentation and follow-up form
Academy reading copy. This lesson is not offered as a file download.
Appendix C — Incident documentation and follow-up form Data protection Restrict completed forms. Collect only necessary information, store securely, follow local privacy/safeguarding law, and set a deletion/review date. Do not promise confidentiality beyond legal duties.
CASE CONTROL ENTRY Case ID Recorder / role Date and time opened / timezone Current response level 1 / 2 / 3 / 4 Decision lead / alternate Next review time Access restriction / retention date Person affected — obtain consent and minimize data FIELD ENTRY Preferred name and safe contact Pronunciation / language / communication access Immediate safety or medical need Children / safeguarding / dependent needs Consent for institutional contact Yes / No / Limited to: Consent for public communication No by default.
Specific approval: Support person / advocate What happened — facts before interpretation FIELD ENTRY Date / time / timezone Location / platform / URL Exact words or behavior Target named or implied Method / capability / access / timing Witnesses and safe contacts Damage / injury / disruption What is verified What is supported / disputed / unknown Why antisemitic motive is suspected Identity reference / trope / symbol / pattern / admission / other: Evidence log — preserve originals ITEM SOURCE / URL CAPTURE TIME ORIGINAL STORED WHERE ACCESS / HASH / NOTES 1 2 3 4 Actions and follow-up TIME ACTION / DECISION OWNER REPORT / REFERENCE NEXT STEP / DATE Recovery and closure
Affected person’s stated needs and choices were reviewed.
Emergency / police / institutional / platform / civil-rights follow-up is assigned.
Medical, mental-health, pastoral, legal, cyber, financial, or practical referrals were offered as appropriate.
Public communication, if any, was consented, factual, and privacy-safe.
The case was included in aggregate trend review without unnecessary identifying data.
Corrective actions have owners and dates; closure was communicated to the person where appropriate.
Retention/deletion decision: ____________________ Review date: ____________________