Online Violence Reporting form

We've tracked homophobic harassment, bias & prejudice motivated violence, family, relationship and intimate partner violence & other incidents of violence including lateral violence in Victoria against & within the LGBTi communities for 20 years. Making a report helps us to support you, assists in designing effective programs to support victims, to prevent harassment, family violence & hate crime from occurring and to work towards the development of third-party and assisted reporting systems.

IF YOU ARE IN IMMEDIATE DANGER
CALL POLICE ON 000
SPEAK WITH THE OPERATOR AND TELL THEM THE MATTER IS URGENT

When you are safe, please let us know of your experience. We will assist you in making contact with police and other services.

WE ADVOCATE FOR THE ESTABLISHMENT OF THIRD-PARTY & ASSISTED REPORTING SERVICES LIAISING WITH POLICE IN VICTORIA, WHICH IS LGBTi COMMUNITY-LED & FUNDED TO DO SO!

2. Why makes you feel this was the case? Please briefly tell us in your words why.

3. Are you the victim or do you have personal knowledge of this happening to another person or group of people? (please note, the police currently do NOT accept third-party reports of violence, although AVP are lobbying for this to occur)

4. What was the date of the incident?

5. Sometimes violence occurs in a pattern - What day did this occur?
Pick the day of the week. If not known, select "Unknown" *This question is required.

6. What Month did this occur?
Select the Month from January through to December. If you are uncertain, please select "Month is Unknown"

7. What Year did this occur?
Please select from the drop down list.

8. Where did the violence you are reporting take place?
(please select from the list) *This question is required.

9. If "Other", please specify

13. What was did the perpetrator say?

14. Victim's age

15. Other victim's age (where a second person experienced violence at the same time as the primary person)

16. Which city, suburb or location name did this event take place?

17. Which Australian State did this event take place?

18. If the event took place in another country, which country.

19. Has this event been reported to police?

20. If "Yes" - the event was reported to police, which police station or police telephone number, eg,
Richmond police station, or "000"

21. If you DID report to police, what was your experience of reporting the incident to them?

22. If you DID NOT report the incident to police, please share the reasons why you didn't:

This information in this section will be separated from any identifying information in the next section, to protect your privacy.

23. What is your age?

The next section is about you. This information is confidential and between you and us - we will respect & protect your privacy.

If you want us to share your information with another person/s or organisation, you MUST indicate that you consent to this.

26. What is your name?

27. What is your phone number?

28. What is your email address?

29. Do you consent to us sharing this information? *This question is required.

30. Who would you like us to contact on your behalf?

Police
Sexual Assault service (CASA)
Other (please tell us who) Please enter an 'other' value for this selection.

Online Violence Reporting form

Page One

IF YOU ARE IN IMMEDIATE DANGER CALL POLICE ON 000 SPEAK WITH THE OPERATOR AND TELL THEM THE MATTER IS URGENT

When you are safe, please let us know of your experience. We will assist you in making contact with police and other services.

WE ADVOCATE FOR THE ESTABLISHMENT OF THIRD-PARTY & ASSISTED REPORTING SERVICES LIAISING WITH POLICE IN VICTORIA, WHICH IS LGBTi COMMUNITY-LED & FUNDED TO DO SO!

This information in this section will be separated from any identifying information in the next section, to protect your privacy.

The next section is about you. This information is confidential and between you and us - we will respect & protect your privacy. If you want us to share your information with another person/s or organisation, you MUST indicate that you consent to this.

IF YOU ARE IN IMMEDIATE DANGER
CALL POLICE ON 000
SPEAK WITH THE OPERATOR AND TELL THEM THE MATTER IS URGENT

The next section is about you. This information is confidential and between you and us - we will respect & protect your privacy.

If you want us to share your information with another person/s or organisation, you MUST indicate that you consent to this.