Incident Reporting Form (Online)

Have you been the victim of anti-Muslim harassment or discrimination? Harassment can be anything from verbal abuse, nasty looks to physical assault.

Please try to fill in as much detail as possible. All information is treated in the strictest confidence and no information will be passed on to any third party without your consent. For more information, please contact 020 8904 4222 or email info@ihrc.org.

Date of incident

Your Name (preferable but optional)

Your Address (preferable but optional)

Country

Your Telephone Number (preferable but optional)

Your Email (preferable but optional)

Description (please try to describe as much as you can of the attack, the attackers, the time of day etc, what was said to you)

Was the incident reported to the police or any other agency?
Yes No

If so which?

What was the outcome?

Comments (This can relate the police treatment of your case, or any other general comments)

Date of filling in this form

Recorded by (please indicate if you are not the victim and how you know about the attacks)

Would you be happy for us to report part or the whole of this incident to the police?
Yes No

Would you like an IHRC case worker to contact you?
Yes No