Report an incident Helpful tip Keep evidence (photos, messages, timestamps) Seek medical help if needed; ask police for an incident number Reach out to support services and community leaders Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. - Step 1 of 2Name *Phone *Email *Address *State *VictoriaNew South WalesQueenslandWestern AustraliaSouth AustraliaTasmaniaZip Code *Type of Incident?Physical Assault, Violence & ThreatsGraffiti/VandalismDiscrimination at workplace/school or by authoritiesNon-Verbal IntimidationOnline Harassment & Hate SpeechStereotyping & Cultural MisrepresentationPolitical & Social MarginalizationWho is filling out this form?VictimVictim’s friend/family/relative/proxyWitness/bystander Incident Details Date / Time *DateTimeLocation * Please mention Incident placeType of Place *Temple, Workplace, School, Public Space, Online, OtherDescription of Incident * Visual Code Next Upload supporting evidences Photos / VideosScreenshots (for online harassment)Police Report Number (if filed)Impact on Victim *Emotional / Psychological harmPhysical injuryFinancial lossCommunity impactCheckboxes *Reported to Police / AuthoritiesReported to Employer / InstitutionNo Action TakenOther (please specify)Please mention all the actions is filed) Report Do you consent to share this report with authorities? *YesNoWould you like support services? *General CounsellingMental CounsellingCommunity SupportLegalNo support requiredSubmit
