2016 preview What type of incident are you reporting? * Something racist in the media or on the internet? Physical harm / abuse / damage / discrimination? Graffiti? Who did it happen to? Me Someone Else Media/ Internet Date of Publication Where was it published? Do you have a screen grab or URL? If screen grab, upload it here Drop a file here or click to upload Choose File Maximum file size: 33.55MB If you have an URL please insert here. If neither, please describe the content. How did you find out about it? I saw it. I heard about it. A client / service user Referring NGO? Please select organisation, if applicable:Canal Communities Doras LuimniDonegal Failte Isteach Project Irish Traveller MovementNASC, The Irish Immigrant Support CentreOffaly Traveller MovementThe Immigrant Council of IrelandCultúr How would you best describe the person(s) this happened to? Mixed background White Irish White - Traveller White - other European White - non-European Roma Black - African Background Black - Irish Black - Other Kurdish Arab Asian - Chinese Asian - South Asian ( Inc. Bangladeshi, Pakistani, Indian) Filipino OtherOther Tick all that apply Was it aimed at a religious group? Tick all that apply Muslim Jewish Christian No religion OtherOther Why do you think the incident was racist? Racist language was used Language about the person's religion was used There did not appear to be any other motive It was about something else, but racism came into it Are you a member of the targeted group? Yes No Please describe the impact it had on you ( in English if possible) Did you report this to anyone else? Broadcasting Authority of Ireland Press Ombudsman Advertising Standards Authority An Garda Siochana (police) OtherOther What was their response? We may wish to contact you to discuss it further. If you agree, please provide your contact details. Name Email Address Phone number Graffiti Date Graffiti was seen? Where was it seen? Select CountyAntrimArmaghCarlowCavanClareCorkDerryDonegalDownDublinFermanaghGalwayKerryKildareKilkennyLaoisLeitrimLimerickLongfordLouthMayoMeathMonaghanOffalyRoscommonSligoTipperaryTyroneWaterfordWestmeathWexfordWicklow Who did this happen to? I saw it I heard about it A client/ service user Referring NGO Please select organisation, if applicable:Canal Communities Doras LuimniDonegal Failte Isteach Project Irish Traveller MovementNASC, The Irish Immigrant Support CentreOffaly Traveller MovementThe Immigrant Council of IrelandCultúr Was it near...? Public Transport School Religious or ethnic community building OtherOther Do you have a photo of the graffiti? Yes No Upload photo here Drop a file here or click to upload Choose File Maximum file size: 33.55MB Please describe the Graffiti Was it aimed at an ethnic Group? Mixed background White Irish White - Traveller White - other European White - non-European Roma Black - African Background Black - Irish Black - Other Kurdish Arab Asian - Chinese Asian - South Asian ( Inc. Bangladeshi, Pakistani, Indian) Filipino OtherOther Tick all that apply Was it aimed at a religious group? Tick all that apply Muslim Jewish Christian No religion OtherOther Do you know who did it? Yes No Please describe Did you report this to anyone else? What was their response? Are you a member of the targeted group? Yes No Please describe the impact it had on you? In English if possible We may wish to contact you to discuss it further. If you agree, please provide your contact details Name Email Address Phone number About you (all of this information is confidential and optional Please describe your ethnicity Mixed background White Irish White - Traveller White - other European White - non-European Roma Black - African Background Black - Irish Black - Other Kurdish Arab Asian - Chinese Asian - South Asian ( Inc. Bangladeshi, Pakistani, Indian) Filipino OtherOther Tick all that apply Are you..? Muslim Jewish Christian No religion OtherOther Your Age group Select OneUnder 1818-2425-3435-4445-5455-6465 or Above Are you Male Female Transgender With a disability Lesbian, Gay or Bisexual Tick all that apply Are you ...? Asylum seeker Undocumented Refugee Visa holder Irish citizen EU citizen We may wish to contact you to discuss it further. If you agree, please provide your contact details. Name Email Address Phone 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) What date did it happen on What time did it happen 121234567891011 : 0030 AMPM If you are not sure, please let us know here approximately when it was Please give details of what happened. Violence Assault ( someone was touched or injured) Sexual Assault Use of a weapon Threats to kill or cause serious harm Abuse: verbal abuse repeated harassment threats written abuse in the form of letters or emails telephone abuse graffiti display of racist insignia or symbols display of other offensive materials offensive "joke" Theft Something was stolen Damage House/Garden Personal Effects (phone, electronics, clothing etc.) Vehicle Business Discrimination: Given poor service Refused service Refused entry At work Applying for a job Finding somewhere to live Encouraging discrimination by someone else Note: If you have a photo or video of the incident there is a file upload option on the last page Racist Statements Leaflets or other materials Recruitment to a racist organisation Encouraging others to behave in a racist way Were there injuries? Give details Were you the only person targeted in this incident? Yes I was alone (1) I was in a group (2 - 4) I was in a group (5 - 10) I was in a large group (10+) Which part of Ireland? Select CountyAntrimArmaghCarlowCavanClareCorkDerryDonegalDownDublinFermanaghGalwayKerryKildareKilkennyLaoisLeitrimLimerickLongfordLouthMayoMeathMonaghanOffalyRoscommonSligoTipperaryTyroneWaterfordWestmeathWexfordWicklow Where did this happen Home Friend’s home Pub / club Shops Place of entertainment (hotel, cinema, leisure centre, sports pitch) Place of worship Work School or University Taxi or rank Train / bus or station Street Direct Provision Centre OtherOther Please describe the incident here, giving as much detail as possible. Take all the space you need Tell us what happened Why did you think the incident was racist Racist language was used Language about the person's religion was used My clothes were of a particular religion or ethnic group There did not appear to be any other motive It was about something else, but racism came into it OtherOther Please describe the impact it had on you (In English if possible) About the offender Do you know them Stranger Neighbour Carer, or support worker Work colleague A person at school/college/youth group Staff member in a public service organisation (Council, Housing, Libraries, Schools, Public Transport, Garda, etc.) Friend OtherOther How many offenders were there? 1 2 3 4 5 or more Not sure Were they....? Male Female Not sure Tick all that apply Are they...? White Irish Irish Traveller White European White Non-European Roma Black-African Black-Other Arab Chinese South Asian (inc. Bangladeshi, Pakistani, Indian) Person of mixed background OtherOther Tick all that apply Age group Under 18 18-24 25-34 35-44 45-54 55-64 65 or Above Was the offender under the influence of....? Drugs Alcohol None of these Not sure Is this part of a pattern of harrassment? Yes No Help & Reporting Did you report this to anyone else? An Garda Siochana (Police) A trade union (SIPTU, ICTU, Mandate, UNISON, INTO, TUI, USI, UNITE, PSEU) Equality Tribunal or Employment Appeals Tribunal Irish Human Rights and Equality Commission (IHREC) Citizens information centre Ethnic minority, migrant or anti-racist organisation County council / City Council Housing charity / PRTB Health organisation School, College, University Public transport organisation Sports organisation OtherOther Give the name of the organisation if not specified above. What was their response? If you didn't report this to the police, why was this? Not serious enough Poor response from Gardai (police) to previous incidents I did not think the Gardai (police) would do anything Worried about the offender’s response I felt ashamed or embarrassed I would have had to disclose personal details about myself I would not feel comfortable talking to police Bad experiences with police in another country The incident is very common I didn’t know how to report it OtherOther Tick all that apply What would encourage you to report this incident to the Gardai? Anonymous reporting Self-report form Someone else would report to Gardai for you Police officer of same ethnic/religious group OtherOther (Tick all that apply) plus1 Add minus1 Remove Reporting for someone else How did you find out about it? I saw it. I heard about it. A client / service user Referring NGO? Please select organisation, if applicable:Canal Communities Doras LuimniDonegal Failte Isteach Project Irish Traveller MovementNASC, The Irish Immigrant Support CentreOffaly Traveller MovementThe Immigrant Council of IrelandCultúr About the victim How would you best describe the person(s) this happened to? Mixed background White Irish White - Traveller White - other European White - non-European Roma Black - African Background Black - Irish Black - Other Kurdish Arab Asian - Chinese Asian - South Asian ( Inc. Bangladeshi, Pakistani, Indian) Filipino OtherOther Tick all that apply Was it aimed at a religious group? Tick all that apply Muslim Jewish Christian No religion OtherOther Age group Under 18 18-24 25-34 35-44 45-54 55-64 65 or Above Other characteristics Male Female Transgender With a disability Lesbian, Gay or Bisexual Tick all that apply Are they ...? Asylum seeker Undocumented Refugee Visa holder Irish citizen EU citizen Not sure We may wish to contact you to discuss it further. If you agree, please provide your contact details. Name Email Address Phone 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) What date did it happen on What time did it happen 121234567891011 : 0030 AMPM If you are not sure, please let us know here approximately when it was Please give details of what happened. Violence Assault Sexual Assault Use of a weapon Threats to kill or cause serious harm Abuse: verbal abuse repeated harassment threats written abuse in the form of letters or emails telephone abuse graffiti display of racist insignia or symbols display of other offensive materials offensive "joke" Theft Something was stolen Damage House/Garden Personal Effects (phone, electronics, clothing etc.) Vehicle Business Discrimination: Given poor service Refused service Refused entry At work Applying for a job Finding somewhere to live Encouraging discrimination by someone else Note: If you have a photo or video of the incident there is a file upload option on the last page Racist Statements Leaflets or other materials Recruitment to a racist organisation Encouraging others to behave in a racist way Were there injuries? Give details How many people did it happen to? 1 2-4 people 5-10 people 10 or more people Which part of Ireland? Select CountyAntrimArmaghCarlowCavanClareCorkDerryDonegalDownDublinFermanaghGalwayKerryKildareKilkennyLaoisLeitrimLimerickLongfordLouthMayoMeathMonaghanOffalyRoscommonSligoTipperaryTyroneWaterfordWestmeathWexfordWicklow Where? Home Friend’s home Pub / club Shops Place of entertainment (hotel, cinema, leisure centre, sports pitch) Place of worship Work School or University Taxi or rank Train / bus or station Street Direct Provision Centre OtherOther Please describe the incident here, giving as much detail as possible. Take all the space you need Tell us what happened Why did you think the incident was racist Racist language was used Language about the victim's religion was used The victim wore clothes that were of a particular religion/ ethnic group There did not appear to be any other motive It was about something else, but racism came into it OtherOther Please describe the impact it had on the victim (Health, avoiding certain places, impact on work or studies, impact on family or community) (In English if possible) About the offender Does the victim know them? Stranger Neighbour Carer, or support worker Work colleague A person at school/college/youth group Staff member in a public service organisation (Council, Housing, Libraries, Schools, Public Transport, Garda, etc.) Friend OtherOther How many offenders were there? 1 2 3 4 5 or more Not sure Were they....? Male Female Not sure Tick all that apply Are they...? White Irish Irish Traveller European Non-European Roma Black Black-African Black-Other Arab Asian Chinese South Asian (inc. Bangladeshi, Pakistani, Indian) Person of mixed background OtherOther Tick all that apply Age group Under 18 18-24 25-34 35-44 45-54 55-64 65 or Above Was the offender under the influence of....? Drugs Alcohol None of these Not sure Is this part of a pattern of harrassment? Yes No Help & Reporting Did you or the victim report this to anyone else? An Garda Siochana (Police) A trade union (SIPTU, ICTU, Mandate, UNISON, INTO, TUI, USI, UNITE, PSEU) Equality Tribunal or Employment Appeals Tribunal Irish Human Rights and Equality Commission (IHREC) Citizens information centre Ethnic minority, migrant or anti-racist organisation County council / City Council Housing charity / PRTB Health organisation School, College, University Public transport organisation Sports organisation OtherOther Give the name of the organisation if not specified above. What was their response? If the victim didn't report this to the police, why was this? Not serious enough Poor response from Gardai (police) to previous incidents I did not think the Gardai (police) would do anything Worried about the offender’s response I felt ashamed or embarrassed I would have had to disclose personal details about myself I would not feel comfortable talking to police Bad experiences with police in another country The incident is very common I didn’t know how to report it OtherOther Tick all that apply What would encourage you to report this incident to the Gardai? Anonymous reporting Self-report form Someone else would report to Gardai for you Police officer of same ethnic/religious group OtherOther (Tick all that apply) plus1 Add minus1 Remove Thank you for taking the time to report racism. To print, please select the print button (Last on right) below.