Harassment Report

Your name (OPTIONAL)
Your email address (OPTIONAL)
Name of person who was harassed/bullied/attacked (OPTIONAL)
Date and Time of Alleged Incident*
Where did the incident occur?*
Did the incident happen directly to you or did you witness it happening to another person?*
- Happened to me
- I witnessed it
Full name of person who you allege harassed/attacked you or another person*
Do you (or the harassed person if not you) know this person or have any prior dealings with them?
Describe the incident(s) as clearly as possible. Include a full description of the events and any verbal statements (threats, requests, demands etc) and what, if any, physical contact was involved.*
If you are able to or would like to name any witnesses to the incident, please list their names/details
How did you or the person harassed (if not you) react to the incident at the time?*
This complaint is based on the honest belief that the above named individual has harassed me or another person. I hereby certify that the information I have provided in this complaint is true, correct and complete to the best of my knowledge and I would be happy for it to be provided as evidence should the complaint require reporting to the police.*
- I AGREE