Bias reporting form possibilities

Hi, colleagues –

Clerk’s committee has been discussing how best to address concerns from students about their classroom environments. In the list of demands published November 22nd, one of the items was this:
In discussing this issue, we have some difficulties with the mechanics of how best to meet this demand. We are in the early-to-middle stages of discussions about revising our course evaluations, but that process is not likely to move quickly enough to provide a timely response to student concerns. Also, course evaluations are an imperfect reporting tool for a number of reasons, including that they come at the end of the semester, past when changes could be made, and they are not guaranteed to be read by the faculty member or by a supervisor (dean or department chair) who could take action.
I created a mock-up of an incident reporting form we could propose as an alternative to the course evaluation model. We’ve discussed this briefly in Clerk’s Committee, but it is by no means an approved proposal or even a model we are committed to. I just thought I’d ask for feedback on whether you think this might be workable, or what changes you think might make it more effective. Here it is:
We do have a bias incident report form on the Intranet, but my understanding is that it is not widely known and is not intended specifically for classroom incidents. It is here:
Some students have also created their own version of a form like this, but it sends responses to the form’s authors rather than to faculty, so the chain of reporting is not yet clear. The student designed form is here:
Let me know what you think about any of these options, either by direct e-mail to me ( or by commenting below.