Hamilton Human Rights Commission Confidential Reporting Form
All sections of this form are optional. This form can be used to report an incident involving yourself or others, ask questions, provide feedback, or to share a positive experience from around town
Type of report
Clear selection
Personal and Contact Information:
Name
Street Address
City/Town
Zip Code
Phone number
Email Address
Rights Violation/Incident Report (please scroll to bottom section to share general feedback, questions, or positive experiences)
In what area(s) do you believe your rights were violated? (check all that apply)
If "other" please describe
Why do you believe your rights were violated? (check all that apply)
If "other" please describe
Has there been more than one incident where you felt your human rights were violated?
Clear selection
Please summarize the incident(s) to the best of your ability
When did the incident(s) take place?
MM
/
DD
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YYYY
When did the incident(s) take place? (only input for more than one occurrence)
MM
/
DD
/
YYYY
When did the incident(s) take place? (only input for more than one occurrence)
MM
/
DD
/
YYYY
What actions do you hope to see happen and/or how would you like the Hamilton Human Rights Commission to best support you?
Is there anything else about your rights violation(s) that you wish to share?
If you have previously reported the violation(s) to another agency please indicate which below. (check all that apply)
Information About Respondent
Please use the following section to input any information you would like to share about the individual(s) or entity you feel violated your rights
Did the incident(s) occur in the town of Hamilton?
Clear selection
If no, in where did the incident(s) occur?
Name of Respondent (if applicable)
Name of Business, Government Body, or Institution (if applicable)
Street Address
City/Town
Zip Code
Phone Number
Email Address
The following Section can be used for general feedback, questions for the HHRC, or to share positive experiences
Please Speak Freely
Submit
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