Incident Report

Incident Report

It is a goal of the Jewish Federation of Greater Portland's Security Intiative to identify and assess any potential threats to our community. It is extremely important to report incidents as soon as you witness them. We are collecting all information that affects our community including Anti-Semitic acts. Please use this form to report all suspicious activity and Anti-Semitic acts. This information will be reviewed and shared with the appropriate local, state and federal law enforcement for action and resolution.
Name*

First Name Last Name
Phone Number*
Please enter a valid phone number.
Email
example@example.com
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Date of Incident*

MonthDay Year
Date
Nature of Incident*

BullyingGraffitiVerbalPhysicalDigital PostOther
Location of Incident (be specific)*
Description of Incident*
Were there any witnesses other than yourself?*

YesNo
Witness name and contact information
Was a police report filed?*

YesNo
Case number/incident number
Law enforcement agency
Officer name (if known)
Was a report filed with the ADL?*

YesNo
Contact name at the ADL (if known)
Do you have any documentary evidence of the incident?*

YesNo
What type of documentation do you have? (check all that apply and upload or comment below)

PhotoLicense plate numberScreenshotOther
Car make and model (if relevant)
License plate number (if relevant)
Add information or comments about your documentation
File Upload (optional)

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Can you describe the offending individual?*

YesNoDid not see
Gender
Age
Weight and height
Race/complexion
Hair and eye color
Add any other description of the individual (be specific):
Would you like the above information to remain confidential with our Community Security Director?*

YesNo
Would you like to be put in contact with our Community Chaplain?*

YesNo
Should be Empty: