Report it! online form

Tell us what happened

Please note: this report is NOT a formal complaint. If you want to make a formal complaint of discrimination, tick the box at the end of this form and include your contact details so we can contact you about the incident and whether or not it might be discrimination.

Details of the person making this report



Telephone: * no spaces (12345678)


Are you the person who was abused or harassed?

If not, how do you know them

eg, friend, family member, community worker, don't know them

Details of person who was abused or harassed

(OPTIONAL- the person can be anonymous)



Telephone: * no spaces (12345678)



If other,


Is the person

If other,

Tell us about what happened

When did it happen (if known)

Date and time

Where did it happen?

eg, street, shopping centre, mall, bus stop, shop, service, park, work, school, public transport, sport, etc


Did you report the incident?

If yes, who to?

eg, police, teacher, manager, service provider, other

If not, why not?

eg, didn't know I could, too scared, too busy etc

What happened?

Why do you think it happened? For example, was it because of your:

If, other  

How did it make you feel?

Did anyone try to help?

Who was responsible (if known) eg, name/organisation

Contact details/Other identifying information

eg, number plate, address etc

How do you know the person responsible?

eg, I don't, co-worker, boss etc

Do you want us to contact you to talk about this further or explain how to make a discrimination complaint?

If yes, please ensure we have your contact details
Personal information will be managed in accordance with the Personal Information Protection Act 2004 and may be accessed by the person to whom it relates on request, in writing, to Equal Opportunity Tasmania.