Online Incident Reporting Form
The mission of the SAFE Washington Program is to create a culture of security in Washington State, and empower everyone to become a "First Responder."
We will accomplish this goal primarily through good communication, community awareness, and training.

SAFE Washington is a Mark Bloome initiative, and is a partnership program by the Jewish Federation of Greater Seattle(JFGS), Secure Community Networks(SCN), Setracon, Temple De Hirsch Sinai(TDHS), and the Anti-Defamation League-Pacific Northwest(ADL).

It is a goal of SAFE WA to identify and assess all potential threats to our community.
It is also extremely important to report incidents as soon as you witness them while the information you have is fresh in your mind.
Please remember - that we are collecting all information that affects our Jewish Community to include anti-Semitic and suspicious behavior. This information is collected and stored indefinitely.

Please use this form to report all suspicious activity and anti-Semitic acts. This information will be reviewed and shared with the appropriate local, state and federal law enforcement agencies for action and resolution.

Please note, for all actual emergencies, dial 911 immediately, and get a police response.

After you have seen a response, get a police report number and visit this page so that we can log the incident, and get an appropriate follow-up response.

Date of Incident *
Approximate Time of Incident *
What was the nature of the incident? (Please check all that apply) *
Location of Incident (Please be specific) *
Your answer
Were there any witnesses (other than yourself)? *
Was a police report filed? *
Police Report Number, Police Department you worked with and the officer's name/badge number.
Your answer
Do you have any documentary evidence? (photos, paperwork, license plate number, screenshot) *
Was there more than 1 suspect? *
Description of Suspect: Please list - Gender, Age, Height, Weight, Race, Hair Color, Eye Color, Complexion, Facial Hair, Glasses, Scars, Tattoos, Jewelry, Clothing Style.
Your answer
Was there a vehicle involved? Please describe, Color, Make, Model, hardtop, convertible, dents, missing parts, loud or quiet? License plate number?
Your answer
Chronological Statement of what happened: *
Your answer
In your opinion, was this incident specifically anti-Semitic in nature? (If Yes; Please explain) *
Your answer
Your First Name *
Your answer
Your Last Name *
Your answer
Your email address *
Your answer
Your phone number (preferably cell phone) *
Your answer
If you see something, say something
Never submit passwords through Google Forms.
This form was created inside of SAFE Washington. Report Abuse - Terms of Service - Additional Terms