Racist Incident Reporting Form

  1. Information about the collecting organization
  6. Did you experience the incident or were you a witness?
  9. The following questions apply to an incident of a racist nature
  11. Was the good or service provided by
  13. Types of goods or services
  15. Was the employment in:
  17. When / where did you experience racism
  20. What age was the person who experienced the incident?
  22. Details of the person experiencing an incident
  23. What was the gender of the person experiencing the incident?
  26. Details of the perpetrator
  27. Were the perpetrator(s)
  29. Please estimate the age of the perpetrators
  31. What was the gender of the perpetrator(s)
  35. Next Steps
  36. Have you reported the incident to any other organization/authority? (e.g. An Garda Síochána, Garda Ombudsman, Equality Authority, community organization)?
  40. Would you like this organization or INAR to take further action?
 

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