Call it out Step 1 of 6 16% We encourage you to share your own experiences here. Your information will help us to understand and take action against the racism which is directed at First Nations people in the community. Racism, discrimination and race hate are serious matters and we recognise that making a report on this register may be confronting. You can find a list of support services in the Resource page, including Lifeline – 13 11 14. For details on how we use your personal information (including your contact details that we will ask for on the next screen), and the information you provide to this register, please take the time to read our Privacy Policy. If you are under 18 years of age, we encourage you to speak with a parent or guardian and ask them to report your experience on your behalf. Sharing your experience on this register will inform our work and help to institute change, however we will not investigate your reports. If you wish to make a complaint to another body or seek legal advice, please see the Resource page for a list of services that may be able to assist you. Thank you for taking the time to call out racism. Contact details* (Your details are confidential and will not be shared with anyone. Please see our Privacy Policy for more details.)Name* First Email or Phone Number* By registering your experience, you are consenting to the use of your report on anonymous basis within published research and statistical reporting of racism. You will never be identified, but we do need to collect your information. **By registering your experience, you are consenting to the use of your report on anonymous basis within published research and statistical reporting of racism. You will never be identified, but we do need to collect your information. * I Agree Who is filling out this form?* First Nations person who experienced racism Friend or relative of a First Nations person who experienced racism Witness of racism toward a First Nations person The incident was experienced/witnessed…* In Person Online on Social Media In the media (In print, online or on television) As institutional racism (where a system, organisation or institution treats First Nations people differently) Other (Please provide details) Other (Please provide details)What type of racism occurred? (You can select more than one)* Bullying Didn’t recognise cultural rights Discrimination (e.g. treating you differently because you are First Nations) Graffiti Hate speech Institutional Racism Negative attitudes or stereotyping Physical abuse, assault or attack Property damage or vandalism Shunning you or excluding you (e.g. refusing service) Threats or intimidation Verbal abuse Other (Please provide details) If you selected ‘institutional racism’ above, please tell us more about how this racism occurs.Other (Please provide details) If you have reported institutional racism on the previous page, some of the following questions may not be directly relevant but we encourage you to continue and answer the questions that are relevant to the racism you are reporting.Who perpetrated the racism? Employee of an organisation (e.g. security guard, customer service agent) Employer or colleague Government authority/institution Health service employee (e.g. nurse) Justice setting (e.g. prison guard or court house) Media outlet Member of the public unknown to me Other non-government service provider or organisation (e.g. real estate agent or shop) Police officer School/educational place employee (eg. teacher) Someone known to me Unknown Other or further information Other or further information How does the person who perpetuated the racism describe their gender (if known)? Female Male In another way Unknown Not applicable (e.g. the perpetrator is an organisation) Where did the incident occur? In a commercial place (eg bank, shop, club, hotel, mall) Interacting with government institution or service provider (e.g. child protection, Centrelink)’ In a hospital or other medical centre In the Media Online In a police station, courthouse or prison In a private place (e.g. at home, at a relative or friend’s residence) In a public place (eg street, park, sporting facility) On public transport In a school or other educational place (eg pre-school, TAFE) In a workplace Unknown Other or further information Address Location of incident if relevant Suburb State Australian Capital TerritoryNorthern TerritoryNew South WalesQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia Postcode When did the incident occur? This week This month In the last few months In the last year Ongoing Please provide more information about the incident (For example: What happened? Who was there? How did people react?)When sharing your experience, please do not include any details that could identify other individuals (for example, names or addresses).How did the incident make you feel? (Afraid, angry, disappointed, helpless, humiliated, sad, shame etc.)How did the incident impact you (including long-term impacts)?What was your age (or the person who experienced the racism) at the time of the incident? 0-9 10-19 20-29 30-39 40-49 50+ Not applicable/unknown How do you, or the person who experienced the racism, describe your gender (if known)? Female Male In another way Unknown Can you tell us more about the perpetrator of the racism? (i.e. age, cultural identity, relationship to the person affected etc.)When sharing your experience, please do not include any details that could identify other individuals (for example, names or addresses). How did you respond to the incident? (You can select more than one) Talked to family or friends I didn’t know what to do, so I didn’t do anything I didn’t believe that anything could be done Reported to the police Reported to a discrimination body (eg. the Australian Human Rights Commission, State/Territory Discrimination board) Retaliation Defended the person/myself verbally Other or further information Other or further information What needs to be done to combat racism? (For example: education, stronger protections and penalties, advocacy)If we need further information regarding your report, can we contact you? Yes, you can contact me No, I don't want to be contacted We will only contact you if we need further information or if we can offer you support regarding the incident.EmailThis field is for validation purposes and should be left unchanged. Δ
