Friday, April 14, 2006

Racist Incident Reporting Form Page 3

21. How has the incident(s) affected you/ the person who experienced racism? (You may attach additional pages)-iipj ir ii1I

22. Who was responsible for the racist incident(s)? An individual An institution (go to question 27) A group of people Unknown

23. Did you/the person who experienced racism know the person(s) responsible for the incident(s)?

( )Yes ( ) Unknown ( ) No If yes, how would you describe your relationship with them? ( )Neighbours ( )Work colleagues ( )classmates ( ) Other

24. How would you describe their ethnic background?

25. What was their gender?

( )Male ( )Both male and female ( )Female ( ) Unknown

26. How old were they?

( ) Younger than 10 40-49 years ( ) 10-19 years E 50-59 years ( ) 20-29 years ( ) Older than 59 years ( ) 30-39 years ( ) Unknown

27. What do you think motived them to commit this act?

28. Did anyone else witness the incident? Lives

( )Not known ( ) No If yes, how did they react? About reporting the racist incldentrs);0]

29. Was the incident(s) reported to any other agency?

( ) Unknown (go to question 39 ( ) No (go to question 34)

30. Who was the incident(s) reported to?

( ) Anti-Discrimination Commission Queensland ( ) Police ( ) Human Rights and Equal Opportunity Commission ( ) Teacher ( ) Health Rights Commission Queensland []Employer ( ) Tenants’ Union of QueenslandQ Other (please specify)

0 Comments:

Post a Comment

<< Home