Incident Report
CONFIDENTIAL - any information you provide will be treated in the strictest confidence and will not be shared without your permission.

Completed reports help to create a picture of what happens at protests. Thank you.

When you submit this form, you will receive an email confirmation with a record of your response. You can use the link in this email to edit this if you wish.

Email address *
Date *
Your answer
Time *
Your answer
Location *
Your answer
Name *
Your answer
Preferred contact details *
(Phone/Email)
Your answer
Brief description of incident *
(e.g. MANHANDLED / ASSAULTED / INJURED / ARRESTED / THREATENED / VIOLATED / TARGETTED / INTIMIDATED / VERBALLY ABUSED / MISSILE THROWN AT YOU / DRIVEN AT etc.)
Your answer
Were you involved / were you a witness? *
Your answer
Details of who was involved *
(e.g. POLICE COLLAR NUMBERS / SECURITY SIA NUMBERS / OTHER)
Your answer
Had assailants done this before? *
Your answer
Was victim / assailant arrested? *
Your answer
Is there photo / video evidence? *
Your answer
Have you received treatment? *
Your answer
Action required now *
(e.g. HOSPITAL etc.)
Your answer
Witness details *
Your answer
Have you made a statement to Legal Observer? *
Your answer
Are you happy for your details to be passed to a complaints co-ordinator? *
FOR DATA PROTECTION PURPOSES YOU MUST TICK YES BELOW
Required
Full description of what you witnessed / what happened to you. *
Please include positions actions and responses of people, approximate speed and direction of vehicles, etc. If you want to include diagrams, photos or videos, please email protestjustice@gmail.com.
Your answer
Are you willing to make a formal complaint? *
Your answer
Do you need support in making a complaint? *
Your answer
Have you reported it to 101 and got a police reference number? *
Your answer
A copy of your responses will be emailed to the address you provided.
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