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Issues Report Incidents  
 
 

REPORT INCIDENTS
 
It is important that all incidents of discrimination and Islamophobia are logged even if you do not want further action or action is not possible because the offenders are unknown. This helps to build a national picture of the extent and types of discrimination experienced by Muslim men, women and children. However, if you wish, we can help to make a referral or provide advise for further action. If you wish to log more than one incident then fill in separate forms for each one.
 
Date of Incident
Date of Incident:
you may wish to add comment e.g. this is approx. imate date or it is the date discrimination started but is ongoing
   
Person making report
First Name
Surname
Gender Male Female
Phone
Email
Is complaint about yourself?     Yes No
If complaint of someone else?  Yes No
   
Type of Incident

Category 1 – HATE CRIME
  Violence
  Damage to property (e.g. building, car etc including graffiti)
  Verbal Abuse / threats
  Written Abuse / threats
   

Category 2 – INSTITUTIONAL DISCRIMINATION
  Accessing a public service (e.g. police, health service, education, justice system etc.)
  Accessing a voluntary service
  Accessing a private service
  In the work place
   

Category 3  - ONLINE ABUSE

  Email
  Twitter
  Facebook
  Other forms of social media
   

Category 4 – IN MEDIA (coverage that promotes prejudice)
  Radio
  Newspaper
  TV
  Other
   

Category 5 – PUBLIC FIGURES or GROUPS (making comments perceived as promoting hate intolerance / hatred)
  Politicians
  Other public figures
  Right Wing Groups
  Other
   
Details of Victim (s) – if applicable
Name (s)
Gender
Age (s)
Ethnicity
Town / City of Incident
Was discrimination due to:  Faith Race Both
   
Details of Incident
   
Have you taken any Action, if so, include what happened ? (report to police, made complaint etc)
   
Would you like us to provide advice or if appropriate make referral e.g. to police?
   
 
verification image, type it in the box
 
 
 
 
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