Report

    WHAT DO YOU NEED?

    WHO IS FILLING OUT THIS FORM?

    YOUR CONTACT DETAILS:

    NAME

    PHONE

    EMAIL

    PREFERRED CONTACT METHOD

    DETAILS OF INCIDENT (TICK ALL THAT APPLY):

    TYPE OF INCIDENT

    AssaultDamage & Desecration of religious siteThreatening BehaviorAbusive BehaviorHate speechOnline ThreatsTrollingAnti-Muslim literatureBullyingHousing discriminationRacist graffitiGrabbing veilsVerbal assaultRefusal of serviceEmployment discriminationTravel harassmentPolice/SIS/Customs/ImmigrationOther

    INCIDENT SCENE

    INCIDENT LOCATION

    CITY/REGION

    WAS THE VICTIM WEARING ANY RELIGIOUS CLOTHING OR OTHER RELIGIOUS MARKERS (EG. A BEARD) AT THE TIME OF THE INCIDENT?

    INCIDENT DESCRIPTION:

    WAS THIS INCIDENT REPORTED TO POLICE?:

    YesNo

    VICTIM/IMPACTED PERSON’S DETAILS:

    ETHNICITY:

    AGE:

    GENDER:

    MaleFemaleUnknown

    WHY DO YOU THINK THIS INCIDENT OCCURRED?:

    ANY OTHER INFORMATION YOU WOULD LIKE TO INCLUDE IN YOUR REPORT?:

    DECLARATION

    I CERTIFY THAT THE ABOVE INFORMATION IS A TRUE AND ACCURATE RECORD OF THE EVENT.

    YesNo

    ATTACH FILES (IF APPLICABLE)

    Confidentiality. All your personal details such as names, contact numbers and emails that you have submitted will be confidential. All the incidents reported to the Register may be used anonymously in our future reports and academic publications for the purposes of raising awareness about Islamophobia. By submitting an incident report, you consent to the use of the reported incident on an anonymous basis for the above-mentioned purposes.

    Security. All your personal details will be stored securely, and only accessed by FAIR for the purposes stated and in accordance with the Privacy Act 1993.

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