INCIDENT REPORT FORM

(To be filled out in the case of sexual violence)

The Women’s Safety Task Force is collecting information on incidents of violence (i.e. sexual) to women on AV roads. 
The information can be reported by this website, phone or in-person. We are keeping track of this data
for the purposes of prevention, statistics for the community and support to victims. 
If you would like to report your incident officially,
please contact AV Security (tel. 9443090107/9443362691).


Name of Person Completing the Form
Phone
E-mail
Today’s date
Status
Incident

/ Others

Name of the Victim
Community /where living
Age
Nationality
Date of incident
Time of incident
Phone
Email
Was it

Where did it happen? 
( e.g. Were you walking, running/jogging,
cycling or riding a motorized 2 wheeler?
)
 
Were you alone or with company?
Direction of travel
From:
Was anyone else in sight?
Did you try to attract help, and how?
How many attackers were there?
Was he / were they



What happened?
Was the incident...
irritating
threatening
serious
Was any theft involved?
Description of attackers:
 
Age(s):
Nationality

Any special characteristics or behaviour patterns?
Language(s) spoken?
Vehicle(s)?
(try to describe or give make, colour registration number(s) - even part of number - if possible)
Had you ever seen him/them before?
Would you recognize him / them again?
Do you carry a whistle, spray or other deterrent to use in case of attack? If 'yes', did you use it? If not, why?
Do you have any advice to other women so that such an attack could be avoided?
Without mentioning your name, can we make details of this incident known to the rest of Auroville if we decide it would be helpful, specially the description of the attackers and vehicle(s) involved, nature of attack and place/time that it happened?
 
CAPTCHA:
(antispam code)
Has the victim agreed to have this incident reported by you?
May we have your permission to forward this report to AV Security?
  If you would like counselling for trauma support and/or need any additional information please contact us:
The Women's Safety Task Force of AV Health Services - avhs@auroville.org.in
Office tel: 262 2425             24 hr hotline tel: 944-235-6790