Cyber harassment report form

This form is to be used to report incidents of cyber harassment. Please provide as much detail as possible, including any relevant screenshots or other evidence. Your name and contact information will be kept confidential.

Time to complete

2 minutes

Eligibility

Cyber harassment report form can be filled out by any person who is a victim of cyber harassment. The person can be a man, woman, or child.

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Questions for Cyber harassment report form

1.

Cyber harassment is a serious problem that can have a lasting impact on its victims. If you have been a victim of cyber harassment, please take the time to fill out this form. Your information will help us better understand the problem and develop ways to address it.

2.

What is your age?

The answer should be a text input.
3.

What is your gender?

The answer should be a single choice:
  1. Male
  2. Female
  3. Other
  4. Prefer not to say
4.

What is your race/ethnicity?

The answer should be a text input.
5.

Have you ever been a victim of cyber harassment?

The answer should be a single choice:
  1. Yes
  2. No
6.

If yes, please describe the incident/s in detail.

The answer should be a text input.
7.

How did the cyber harassment make you feel?

The answer should be a text input.
8.

Have you ever been afraid for your safety as a result of cyber harassment?

The answer should be a single choice:
  1. Yes
  2. No
9.

Has the cyber harassment negatively affected your work or school performance?

The answer should be a single choice:
  1. Yes
  2. No
10.

Have you ever changed your behavior as a result of the cyber-harassment (e.g., stopped using certain social media platforms, or changed your phone number)?

The answer should be a single choice:
  1. Yes
  2. No
11.

Have you ever contacted law enforcement as a result of cyber harassment?

The answer should be a single choice:
  1. Yes
  2. No
12.

Would you like to provide any additional comments or information about your experience with cyber harassment?

The answer should be a text input.

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Here are some FAQs and additional information
on
Cyber harassment report form

How do I report cyber harassment to the police?

If you believe you are a victim of cyberstalking or online harassment, file a police report with your local law enforcement agency. Many agencies now have a dedicated cyber unit and are familiar with these types of complaints.

How do I report harassment to Facebook?

If you see something on Facebook that you believe violates our Community Standards, you should report it to Facebook. To report a person choose the report profile option.

What information should I include in my report?

Include as much information as possible, including any evidence you may have (e.g., screenshots, emails, social media messages). Be sure to also include the name, address, and phone number of the person you believe is responsible for the harassment.

I’m not sure if what I’m experiencing is cyber harassment. What should I do?

If you are unsure whether the online activity you are experiencing constitutes harassment, you can consult with an attorney or file a report

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