The Anti-Violence Project of Victoria has tracked bias and prejudice motivated crime and other incidents of violence occurring in Victoria against & within the GLBT communities, including relationship violence for 15 years. This helps us to better understand these incidents, effectively design programs to assist victims and prevent hate crimes from occurring and enable people experiencing violence to seek support.
IF YOU ARE IN IMMEDIATE DANGER
PLEASE CALL POLICE ON 000 FOR ASSISTANCE
SPEAK WITH THE OPERATOR AND TELL THEM THE MATTER IS URGENT
When safe, please let us know of your experience. We can assist you in making contact with police and other services.
WE ENCOURAGE AND SUPPORT THIRD-PARTY REPORTING!
1.
Was the person (or were the people) behind the violence acting in the spur-of-the-moment, or had they planned this violence?
Spur-of-the-Moment (unplanned, without previous thought, on a whim)
Planned/Pre-meditiated/Organised
2.
Why do you feel this was the case? Please briefly tell us in your words why.
3.
Have
you
been the victim
of hate-related harassment, property damage or violence or do you have
personal knowledge of violence against another person or group of people
?
-- Please Select --
Have personally experienced this violence.
Have knowledge of this violence happening to others.
4.
What was the date of the incident?
5.
What day did this occur? (sometimes violence occurs on the same day in a pattern)
Pick the day of the week. If not known, select "Unknown"
-- Please Select --
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Unknown
6.
What Month did this occur?
Select the Month from January through to December. If you are uncertain, please select "Month is Unknown"
-- Please Select --
January
February
March
April
May
June
July
August
September
October
November
December
Month is Unknown
7.
What Year did this occur?
Please select from the drop down list.
-- Please Select --
2012
2011
2010
2009
2008
2007
2006
Between 2000 and 2005
Earlier than 2000
8.
What was
the location
of the violence you are reporting?
(please select from the list)
-- Please Select --
Residence (your home)
Residence (their home)
Street/Road/Highway (public place & not secluded)
Laneway/Parking Lot/Garage (public but secluded)
School
Cafe/Restaurant
Nightclub/Pub
Sporting facility or Sports match/competition
Sex-on-premises Venue
Beat or other secluded place
Internet/Social Media Site/Email
Other
9.
If "Other", please specify
10.
Nature of the Incident
(Please select as many choices that apply)
In person - verbal harassment or threats, vilification, hate speech
Telephone - verbal harassment or threats, vilification, hate speech
On-line (internet, social media, chat, email) - verbal threats, vilification, hate speech
Written including vandalism - verbal harassment or threats, vilification, hate speech
Physical Assault - fist/hands/foot or body AS weapon
Physical Assault - with an object as a weapon
Physical Assault - with a vehicle as a weapon
Sexual Assault - touching without consent
Sexual Assault - penetration of any part of the body without consent
Drugs provided/administered (including alcohol or other drugs) limiting ability to choose or say no
Drink Spiking (with drugs or additional alcohol)
Theft of Property
Damage to property
Burglary
Kidnapping
Murder
Prejudice Motivation (hatred towards sexuality, gender, faith, culture)
Blackmail or attempt to coerce or threaten by blackmail (to out a person etc)
Other
11.
Was the violent person in a relationship with the victim or victims?
Yes
No
Unsure
12.
Where language was used by the perpetrator, was it
Anti-Gay
Anti-Lesbian
Anti-Transgender
Racially motivated
Motivated by gender
Prejudice Motivated (sexuality, gender, race/culture, faith)
Other
13.
Please describe the words used by the perpetrator.
14.
Primary victim's age
15.
Other victim's age (where a second person experienced violence at the same time as the primary person)
16.
Which city, suburb or location name did this event take place?
17.
Which Australian State did this event take place?
-- Please Select --
Victoria
New South Wales
Tasmania
Queensland
South Australia
Northern Territory
Australian Capital Territory
Within another Australian Territory
Other Country
18.
If the event took place in another country, which country.
19.
Has this event been reported to police?
Yes
No
Unknown
20.
If "Yes" - the event was reported to police, which police station or police telephone number, eg,
Richmond police station, or "000"
21.
If you DID report to police, what was your experience of reporting the incident to them?
22.
If you DID NOT report the incident to police, please share the reasons why you didn't:
This information in this section will be separated from any identifying information in the next section, to protect your privacy.
23.
What is your age?
24.
What is your gender?
Male
Female
Transgender M2F
Transgender F2M
Intersex
Other (please tell us)
25.
Cultural background - Are you
Anglo
of Aboriginal/Torres Straight Islander descent
Chinese
Indian
Vietnamese
Malaysian
Indonesian
Greek
Italian
German
Korean
Other (please tell us)
The next section is about you. This information is confidential and between you and the Anti Violence Project of Victoria Inc. (VicAVP) and your privacy will be respected & protected.
To allow us to share the information you provide to another person or persons, you MUST indicate that you consent to this.
26.
What is your name?
27.
What is your phone number?
28.
What is your email address?
29.
Do you consent to us sharing this information?
Yes
No
30.
Who would you like us to contact on your behalf?
Police
Sexual Assault service (CASA)
Other (please tell us who)
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