Hate Incident Report Form

Incident Data

Element of Crime or Harassment
Motivation for Crime or Harassment
Action Taken

Victim Information - Individual

Victim's Race

Victim Information - Group

Age Range of Group Victimized
Race Composition of Group Victimized
Gender Composition of Group Victimized

Perpetrator - Individual

Race of Perpetrator

Perpetrator - Group

Ages of Perpetrators in Group
Gender of Perpetrators in Group
Race of Perpetrators in Group