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Subject Information

Who is this report about?*

This will be the name that appears on the documentation.

Their title

Relationship to you

What happened?

Describe the incident in your own words*

Write down what you remember. Don't worry about being comprehensive - there's space for more details ahead.

Here's how this works: Your complete narrative will be included in your PDF. If you choose "I have more details" below, we'll also use this description to help auto-fill additional fields.

When and where did this happen?

Date*

Time

Duration

Location of interaction*

Choose your level of detail: Create a comprehensive report with additional fields, or preview and submit your basic report now.

💡 Note: If you choose "I have more details," our AI will analyze your description to help pre-fill some fields. This may take 10-15 seconds.

Recommended — Adds quotes, behaviors, and impact. AI will help pre-fill fields.

Review and send your basic report

Interaction Details & History

These fields were pre-filled using your earlier description. Please review for accuracy and add more detail where helpful—more specifics make stronger documentation.

What were the exact words they used?

Try to recall their exact words as closely as possible. It's okay if you don't remember everything verbatim.

See examples

Examples:
• "You're not technical enough to understand this"
• "I don't have time to explain everything to you"
• "That's not how we do things here"

What behaviors did you witness?

Document their observable actions, body language, and behaviors.

See examples

Examples:
• Raised voice and spoke over me when I tried to respond
• Rolled eyes when I asked a clarifying question
• Left the meeting abruptly before I finished speaking

Why were you interacting with this person?

How many times has this happened before?

If you are not comfortable estimating a number, leave this blank and add notes to the right.

What behavioral patterns do you notice?

Look for timing, triggers, or recurring circumstances when this behavior happens.

See examples

Examples: Only during 1:1s • When I disagree • When stressed about deadlines • Always in private

Your Safety Matters: Workplace documentation is important, but your immediate safety comes first. If you're experiencing physical threats or severe emotional distress at work, please reach out to HR, your Employee Assistance Program (EAP), or other support services. Nodisa provides tools for documentation and strategy, not crisis intervention or immediate safety support.

I have read and understand this safety notice*

Smart Formatting: The sections below (Impact Assessment, Evidence, Follow-up & Reporting, Additional Information) will only appear in your PDF if you fill them out. Empty sections won't clutter your document. However, questions in the previous two sections will show "—" if left blank.

Your Response

How did you respond during the interaction?

Document your exact words and responses.

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Examples:
• "I was too shocked to respond and just nodded"
• "I said 'I need to think about this' and ended the meeting"
• "I asked for clarification: 'Can you explain what you mean by that?'"

What did you do after the interaction?

Document the actions you took following this interaction.

See examples

Examples:
• Sent follow-up email summarizing the conversation
• Spoke with a trusted colleague about what happened
• Reviewed company policy on [relevant topic]

Impact Assessment (Click to expand)

How did this impact your work?

Describe the impact on your productivity, projects, deadlines, etc.

See examples

Examples:
• Had difficulty concentrating during team meetings for the rest of the week
• Avoided 1:1 meetings for 3 weeks, which delayed important decisions
• Requested to be removed from the project team

How has this impacted your well-being?

Describe any impact on your mental, emotional, or physical health.

See examples

Examples:
• Trouble sleeping for 3 nights, replaying the conversation
• Increased anxiety before work meetings
• Withdrew from team social activities

Evidence (Click to expand)

If there were witnesses, list them here

Privacy note: These people will not be contacted. This is for documentation only.

If you have proof, provide an overview of what you have

Word of caution: recording someone without their knowledge and consent can be detrimental to your case (and your job). If you have recordings, make sure they were obtained through appropriate means. Nodisa Labs does not provide consultation on this; reach out to a legal adviser if in doubt.

See examples

Examples:
• Email correspondence
• Text messages
• Performance reviews

Proof locations

For your eyes only: Consider leaving this blank if you plan to share your PDF with others. You can add this info to your personal copy later.

Follow-up & Reporting (Click to expand)

Have you had additional interactions with this person? If yes, provide some details about what happened.

Document any follow-up interactions and whether the situation improved, worsened, or stayed the same.

See examples

Examples:
• Had 1:1 on [date]; behavior was professional, no issues
• Similar incident occurred during team meeting on [date]
• They apologized via email on [date]; working relationship improved
• Behavior escalated during project review on [date]

Most recent interaction date

Leave blank if the most recent interaction is what you're documenting.

If you have already reported this, to whom did you report this to?

Note: This report will not be sent anywhere, but we suggest speaking to someone if you have more than three reports for the same person.

Additional Information (Click to expand)

Your Documentation, Your Control

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