Report Racist Incidents

Independent, Confidential and Safe


Thank you for taking the time to fill out this racist incident form. By doing this you are helping us to document and understand the problem of racism in Ireland. This will support our argument for better measures to be taken against it.

The information gathered will be treated confidentially and will not be shared with anyone without your permission, unless we are compelled by law to do so.

We will only contact you if you give us your permission to do so.

As you fill out the form below, options will appear in response to your answers to the first question.

Media/ Internet


Tick all that apply
We may wish to contact you to discuss it further. If you agree, please provide your contact details.

Graffiti

Tick all that apply
In English if possible
We may wish to contact you to discuss it further. If you agree, please provide your contact details

About you

(all of this information is confidential and optional
Tick all that apply
Tick all that apply
We may wish to contact you to discuss it further. If you agree, please provide your contact details.

Incident

(If you would like to report 2 or more incidents, please click the add button at the end. You will not have to repeat the information above)
Please give details of what happened.
Note: If you have a photo or video of the incident there is a file upload option on the last page
Tell us what happened
(In English if possible)

About the person who did this

Tick all that apply
Tick all that apply

Help & Reporting

Tick all that apply
(Tick all that apply)

Reporting for someone else


About the victim

Tick all that apply
Tick all that apply
We may wish to contact you to discuss it further. If you agree, please provide your contact details.

Incident

(If you would like to report 2 or more incidents, please click the add button at the end. You will not have to repeat the information above)
Please give details of what happened.
Note: If you have a photo or video of the incident there is a file upload option on the last page
Tell us what happened
(In English if possible)

About the offender

Tick all that apply
Tick all that apply

Help & Reporting

Tick all that apply
(Tick all that apply)
Thank you for taking the time to report racism.

To print, please select the print button (Last on right) below.