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 between community organizations and law enforcement.

It is a goal of SAFE WA to identify and assess all potential threats to our community.

It is 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.

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 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.
Email address *
Date of Incident *
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Approximate Time of Incident *
Time
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What was the nature of the incident? (Check which one applies to your report) *
Required
Location of Incident (Please be specific) *
Your answer
Were there any witnesses (other than yourself)? *
Your answer
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) Please list what you have, we will contact you and ask you to send digital copies. *
Your answer
Description of Suspect(s): - Description, Top Down, Outside to Inside, be sure to include: Gender, Age, Height, Weight, Race, Hair Color, Eye Color, Complexion, Facial Hair, Glasses, Scars, Tattoos, Jewelry, Clothing Style or any other noticed details.
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
Please Confirm Your Email Address *
Your answer
Your phone number (preferably cell phone) *
Your answer
If you see something, say something
A copy of your responses will be emailed to the address you provided.
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