Formulář

Bias (Hate) Attack Report Form

Bias attacks are very serious and often go unnoticed. Thank you for choosing to change this, whether you personally have been attacked or have learned about an attack from someone else. We strive to map bias violence and assist its victims. The attack reported by you will be taken seriously. If you wish, we will get back to you within three business days to discuss possible solutions to your problem. To contact us sooner, please call our hotline at +420 773 177 636. The information provided by you is confidential, and no one but In IUSTITIA personnel will have access to it.

Mandatory Section

What was your role in the attack or in what capacity did you learn about it? Please select one of the following options:

Please specify your role in the attack or how you have learned about the attack:

Please specify for which nationality or ethnicity the perpetrator attacked. Please select one of the following options:

Please specify for which nationality or ethnicity the perpetrator attacked:

Please specify for which sexual orientation or gender identity the perpetrator attacked. Please select one of the following options:

Please specify for which sexual orientation or gender identity the perpetrator attacked.

Please specify for which religion or religious beliefs the perpetrator attacked. Please select one of the following options:

Please specify for which religion or religious beliefs the perpetrator attacked:

How was the attack carried out?

Please specify what kind of verbal attack it was:

Face-to-face

By e-mail or letter

By phone

Please specify what kind of verbal attack it was:

Please specify what kind of intimidation or threats it was:

Face-to-face

By e-mail or letter

By phone

Please specify where the graffiti appeared:

On a religious building, at a cemetery

On other buildings

Please specify whether the physical assault was carried out with or without a weapon. Please consider any object used by the perpetrator for the attack to be a weapon.

With a weapon

Without a weapon

Please describe the bias attack in detail. Try to answer the following questions: WHO was attacked and by whom? WHERE, WHEN and HOW did the attack occur? WHY did it occur (for what reason did the perpetrator attack)? AND WHAT were the CONSEQUENCES of the attack?

Please give the date of the attack. For repeated attacks, please give the date of the most recent one.

The date is only estimated

If you want us to contact you, please fill in your contact details below:

Name/nickname:

Telephone:

E-mail:

Thank you for your answers to the above questions. The following part of the form is voluntary. It will take no more than five minutes to complete. Information about bias attacks is very important. The more information you give us, the better we will be able to help you or the better we will know the state of bias violence in the Czech Republic. Would you like to complete the voluntary section of the form?

YES NO

Conclusion

Without your consent, we cannot process and retain the data you have provided, so the attack won’t be reported. Please check the box if you want to report the attack.

I agree to the processing and retention of all the data provided, including personal data. We will handle the data in accordance with applicable laws, namely Act No. 110/2019 Coll., on Personal Data Protection, and Regulation (EU) 2016/679 of the European Parliament and of the Council. The area of personal data protection is supervised by the Office for Personal Data Protection. You can turn to it with your motions or complaints.

The data processor is In IUSTITIA, o.p.s. (Identification Number 26569655, www.in-ius.cz). We process the personal data provided by you for the purpose of mapping bias violence in the Czech Republic. The personal and contact information provided by you will be retained for a period of two years in an electronic internal database that is secured and can only be accessed by authorized personnel. Once that time passes, the data will be deleted. Other information provided regarding the attack will continue to be stored in the database in an anonymized form. The information about the attack provided by you is not transferred to third parties. We never publish personal data. Other information about the attacks is published through various research reports, which are available on the In IUSTITIA website or in printed form. These reports do not allow for identifying who reported the attack.

You can revoke this consent at any time. After you revoke your consent, personal and contact data that allow for identifying you will be promptly deleted. Other data provided about the attack will subsequently be kept in an anonymized form. You can revoke your consent by e-mail at poradna@in-ius.cz. Furthermore, you have the right to check which personal data about you we are processing and you have the right to have your personal data rectified. Finally, you have the right to have your personal data erased.

Without your consent, we cannot process and retain the data you have provided, so the attack won’t be reported. Please check the box if you want to report the attack.

Bias (Hate) Attack Report Form

Mandatory Section

Voluntary Section

The injured persons

Person 1

Person 2

Person 3

Person 4

Person 5

Person 6

Person 7

Person 8

Person 9

Person 10

Please describe the circumstances of the attack (when and where the attack occurred):

Please describe the perpetrator (the person who attacked):

After the attack: What happened after the attack?

Conclusion