Hate Crime Report Form
Data received with this form will be used only in purpose of Hate Crimes monitoring conducted within the No Borders Project, Social Action Centre. The No Borders Project provides free legal assistance to all hate crime victims by request. The consultations are available via info@noborders.org.ua email or the hotline number 0930351515 24/7 in English, Russian or Ukrainian languages.

The hate crime is a criminal offence conducted with a biased motive. It means the victim was chosen due to her/his/their color, ethnic or national origin, sexual orientation or gender identity, language, disability, etc.

URGENT! THIS FORM IS USED FOR MONITORING ONLY. IF YOU OR ANOTHER PERSON IS IN DANGER< PLEASE INFORM THE LAW ENFORCEMENT AUTHORITIES. IF SOMEONE IS INJURED CALL THE AMBULANCE IMMEDIATELY.

How do you think, what was the perpetrator(s) motive of comminting a crime?
what prejudice was the motive of the perpatrator (color, ethnic or national origin, sexual orientation, languahe, disability, etc.) you may write several points
Your answer
Information about the incident
Date and time of the incident
MM
/
DD
/
YYYY
Time
:
Place
city, disctric, exact place, address
Your answer
Additional Informartion
Is there any description or additional information available?
Who was(were) the perpatrator(s)?
Do you know who commited the crime?
Please, describe the perpatrator(s)
Write down the characteristics of the perpatrator (how they looked like, clothes, tatoos, language, words they used during the incident)
Your answer
Information on the person who fills in the form
Who is reporting the hate crime
Contacts
Please, write down your phone number or email so our interviewer could contact you for details. If you do not want to give us your contacts, please, write why.
Your answer
Do you know if any of the following actions where taken?
Information on victims
Please, write down names of the victim(s). If the crime was commited against property write down the property's owner name (s).
Please, write here the victim(s)' name(s)
If there are several victims, separate the names with coma
Your answer
Contacts
If you are willing us to contact you for legal assistance provision, please write your phone number or email
Your answer
Comments
You can write here any additional comments or questions
Your answer
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