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Conduct Report Form
Conduct Report Form
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Conduct Report Form
"The Guild of Guides NL is dedicated to the safe and ethical use of psychedelics. We support and monitor the quality of our members’ services. One way we do this is with our Accountability Committee. They stand as an advocate for both participants and facilitators/guides. Mediation is available to best address any concerns and as an intermediary in cases of misconduct. All guild members must follow the
Code of Conduct
. If you have a concern about the conduct of one of our members, please use the Conduct Concern Form below to contact our Accountability Committee." This form holds a rating in place with the opportunity to add concerns. This is for our accountability circle to assess the best way forward to honor and address the concern. Please know that your information is private and confidential."
This form holds a rating in place with the opportunity to add concerns. The reason is to assess if misconduct was present and a more detailed questionnaire in person will follow if this is deemed the case by our accountability circle. Please know that your information is private and confidential.
Your name
*
Guide/facilitator
*
Date
MM slash DD slash YYYY
Location
*
Please state below in a few words what your main concerns are.
*
What is the best way to reach you?
*
Did your guide conduct a physical and mental health screening before the ceremony/session?
*
Yes
Some
Minimal
No
Don't recall
Space to elaborate
Did you feel you had the proper information before the ceremony/session?
*
Yes
Some
Minimal
No
Don't recall
Space to elaborate
Did you provide written informed consent?
*
Yes
Some
Minimal
No
Don't recall
Space to elaborate
Did you feel you had the capacity to consent (and by extension had the capacity to deny consent) before, during, and after the ceremony/session?
*
Yes
Some
Minimal
No
Don't recall
Space to elaborate
Did you feel that your guide upheld the professional boundaries?
*
Yes
Some
Minimal
No
Don't recall
Space to elaborate
Did you feel that your guide provided medical advice?
*
Yes
Some
Minimal
No
Don't recall
Space to elaborate
Did you feel there was an alliance and trust relationship before, during and after the ceremony/session?
*
Yes
Some
Minimal
No
Don't recall
Space to elaborate
Did you feel you were supported during the ceremony/session?
*
Yes
Some
Minimal
No
Don't recall
Space to elaborate
Did you feel empowered to advocate for yourself and your needs throughout the ceremony/session?
*
Yes
Some
Minimal
No
Don't recall
Space to elaborate
Did you feel the ceremony/session was held in the proper setting?
*
Yes
Some
Minimal
No
Don't recall
Space to elaborate
Did you feel that your personal information was held with confidentiality?
*
Yes
Some
Minimal
No
Don't recall
Space to elaborate
Did you feel that any unprofessional or unwanted physical contact took place?
*
Yes
Some
Minimal
No
Don't recall
Space to elaborate
Did the way that the space was held feel safe?
*
Yes
Some
Minimal
No
Don't recall
Space to elaborate
Did you feel that any sexual boundaries were crossed?
*
Yes
Some
Minimal
No
Don't recall
Space to elaborate
Did you feel there was an adequate and active role undertaken by the guide to prevent physical and psychological harm?
*
Yes
Some
Minimal
No
Don't recall
Space to elaborate
Did you feel that your guide took care and precaution to protect against the spread of Covid-19?
*
Yes
Some
Minimal
No
Don't recall
Space to elaborate
Did your guide hold the ceremony/session in person?
*
Yes
Some
Minimal
No
Don't recall
Space to elaborate
Did you feel that your guide discriminated based on race, gender, sexual orientation, ability, etc.?
*
Yes
Some
Minimal
No
Don't recall
Space to elaborate
Name
This field is for validation purposes and should be left unchanged.
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