Your Story

Personal Details - Optional

First name:

Town/County:

Email:

LOCATION
Where did incident occur?

Primary School

Secondary School

Third level college

Soccer sports venue

GAA sports venue

Rugby sports venue

Other, please state

TIMING
This section must be completed

Time of incident

Date of incident

TYPE OF INCIDENT:
Please tick box as required

Obscene gesture

Verbal abuse

Physical assault

Racist Literature

Graffiti

Other:

HAVE YOU REPORTED THE INCIDENT TO THE GARDA?

Yes

No

WOULD YOU LIKE AN AUTHORITY WHO YOU COULD REPORT TO?

Yes

No

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