Sonoma County Human Rights Visibility Project

Reporting Form

Please report each incident separately and provide as much information as possible. You may report as often as needed. All answers are confidential and will allow us and our collaborative partners to monitor human rights incidents and issues in Sonoma County during and after Covid-19.

We will not share your identifying information with any individual and or third party including local,

state and federal law enforcement agencies. We will use the data collected to identify areas of need and report statistical information to better improve the human rights and dignity of all Sonoma County residents.

Unfortunately, we cannot respond to submissions. If the matter is urgent, please CALL 911.

Question Title

* 1. Who are you reporting for?

I'm reporting an incident that happened to me.

I'm reporting an incident that I witnessed.

I'm reporting an incident for someone who is unable to make their own report.

Question Title

* 2. Please indicate your ethnicity or the person you are reporting for (check all that apply):

American Indian or Alaska Native

Black or African American

Hispanic or Latinx

Asian or Asian American

Native Hawaiian or other Pacific Islander

Middle Eastern

European American

Please specify your cultural identity (eg, Eritrean, Filipino, Guatemalan, Iranian, Korean, etc)

Question Title

* 3. Please indicate your gender and/or gender identity(check all that apply):

Female

Male

Two Spirit

Transgender

Non-binary

Other (please specify)

Question Title

* 4. Please indicate your age

Under 18

18-24

25-34

35-44

45-54

55-64

65+

Question Title

* 5. Please indicate if any of these circumstances describe you or the person you are reporting for (check all that apply):

I am a DACA recipient

I am a farmworker

I am experiencing homelessness

I am a member of the LGBTQ+ community

I am a person with disabilities

I am undocumented

Other (please specify)

Question Title

* 6. Date of occurrence

Date / Time

Date

Time

AM/PM

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* 7. Place of occurrence

Adult Jail

Business

Educational institution

Foster Care

Government agency

Group home

Health Facility

Homeless Shelter

Juvenile Hall

Law enforcement street patrol

Law enforcement traffic stop

Place of employment

Police Department

Public Transportation

Residence

Residential care home

Other (please specify)

Question Title

* 8. Please choose a topic under the drop down tab that best describes your human rights incident:

Other (please specify)