Hate violence and threats checklist
A printable from Hate violence and threats. Fill it in by hand. Nothing you write is collected by this website.
Printable checklist
Is there an incident record I can print?
Hate incident record
Date and time: ________ Place: ____________
What happened (exact words if you can): ____________
What was said about who I am (race, religion, status, language, orientation, gender, other): ____________
Person who did it (name if known, description, car, plate): ____________
Witnesses and how to reach them: ____________
Injuries or damage: ________ Photos taken? Yes / No
Reported to: [ ] Police (report number ______) [ ] CRD [ ] Employer [ ] School [ ] Other ______
Medical visit: ________ Costs so far: $______
From Hate violence and threats. Facts checked October 21, 2026. Free information, not legal or medical advice.