Kappa Psi Pharmaceutical Fraternity, Inc

Kappa Psi Pharmaceutical Fraternity, Inc.

Formal Violation Report Form

This template is used to aid Chapter Advisors (GCDs) in filing an investigation of any violation of the Fraternity Constitution & By-Laws (C&BL) or Policy and Procedures Manual. This report is to be filed directly with the Grand Regent and Central Office (Executive Director) after any witness or reported violation. This report applies to investigations specific to this Chapter, in the event that more than one chapter is involved, each individual Chapter shall be required to submit their own report. Any questions regarding completion of this report shall be directed to the Grand Regent or Executive Director.

Report Information

Date of Report:______

Chapter Name:______

Grand Council Deputy (writing report):______

Other Grand Council Deputies of the Chapter:______

Reported Violation Information

Date of Violation:______

Date Reported to or discovered by GCD:______

Who discovered and/or reported the violation:______

Members Involved:☐ Whole Chapter ☐ Individual Member(s): ______

Policy(ies) (or C&BL) Violated:______

Section(s) Violated & How:______

Reported Violation Classification*

☐ Mild ☐ Moderate ☐ Severe

*As defined by the Kappa Psi Risk Management Procedures

Investigation Findings

Violation Setting(s):☐ Live Event ☐ Social Media ☐ Other: ______

Was this a Kappa Psi Event or setting?☐ Yes ☐ No

Were non-members involved?☐ Yes ☐ No

If Yes, who?______

Was legal action taken against anyone involved in the incident?☐ Yes ☐ No

If Yes, what happened?______

Was anyone harmed, physically or mentally, during the event?☐ Yes ☐ No

If Yes, what happened?______

Is the School administration aware of the event?☐ Yes ☐ No

If not, will they be notified?☐ Yes ☐ No

If they will not be notified, please explain why:______

If they are aware or will be notified, please list their name(s) and contact information:______

Did the school take any action against or place any sanctions on the chapter as a result of this event?☐ Yes ☐ No

If yes, what happened:______

Who was interviewed as witnesses to the event? ______

Provide details of the event, as it occurred, according to results of the investigation:

______

Investigation Outcomes

What actions were taken by the Chapter (or members) as a result of the violation (include any disciplinary action, if anyone was removed from office, if any education occurred, etc.):______

What future actions will be taken by the Chapter to ensure this violation does not occur again? (include any pending or ongoing investigation or actions, if any plan, programs or process are being put in place, etc.):______

What recommendations, considerations or actions are requested by the Chapter, Member or GCD by the International Executive Committee when the Grand Regent reviews this report?

☐ No further action is required by the International Executive Committee based on appropriate Chapter self-management

☐ A Chapter visit by an International Executive Committee Member is requested

☐ A Chapter visit by a Chapter Enhancement Task Force Member is requested

☐ Request for the Executive Committee to take the following actions: ______

☐ Other: ______