Report an incident online Form

Report an incident
Victim of violence?
Event of violence
Advice
About

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1. Your date of birth*
2 How do you define your gender identity?*
- Female
- Male
- Female (trans* or with a trans* past)
- Male (trans* or with a trans* past)
- Cross-dresser/transvestite
- Transgender
- Transsexual
- Non-binary/genderqueer/gender-fluid
- Agender
- Cisgender/non-trans
- Intersex
- I don't know
- Other
More than one answer possible
2.1 Gender identity: other
3. Were you officially assigned another gender at birth?*
- No
- Yes
4. What is your sexual orientation?*
- Heterosexual
- Lesbian
- Gay
- Bisexual
- Asexual
- Pansexual
- Other
5. How do you disclose your sexual orientation?*
- I openly disclose my sexual orientation.
- I avoid behaviour that could reveal my sexual orientation.
- I decide on a case-by-case basis whether or not I want to openly disclose my sexual orientation.
- When I meet someone new, I am initially cautious about disclosing my sexual orientation.
- Generally speaking, where I live, I feel safe with my sexual orientation.
- I don't think that people see my sexual orientation.
More than one answer possible
6. Where were you born?*
- In Switzerland
- In another country
6.1 In which country were you born?*
6.2 What year did you move to Switzerland?*
Please give the year only (for example, 1984). If you have moved to Switzerland several times, please indicate the year of your first move only.
7. Are you or have you ever been a sex worker?*
- Yes
- No

8. What date did the incident take place?*
If you are not sure, please give an approximate date.
9. What time did the incident occur?*

: hours

minutes

If you are not sure, please give an approximate time.
10. Place and/or address of incident (please be as specific as possible)*
11. Where did the incident take place?*
- At my house/flat
- At someone else's house/flat
- In the street/in a public area
- At school
- At work/place of training
- In a restaurant or cafe
- On a night out /at a party or nightspot
- In a shop
- In a healthcare establishment
- In a public institution
- On public transport/at a public transport stop
- At a sporting/leisure event
- In a park/forest/public toilet
- On the internet/by email
- By post/telephone
- Other
11.1 Other: where did the incident take place?
12. Which of the following have you experienced on the basis of your sexual orientation, gender identity or gender expression?*
- Insults and verbal abuse
- Violent threats
- Being followed
- Physical violence (being pushed, hit, kicked etc.)
- Injury with a weapon
- Sexual harassment
- Sexual assault (e.g. attempted rape)
- Rape
- Refused help in a healthcare setting
- Refused help by authorities
- Refused entry to a public place (entry to a bar, a taxi etc.)
- Refused employment
- Dismissal
- Termination of a housing agreement or similar
- Cyber-bullying
- Online insults, verbal abuse or hate discourse
- Other
12.1 Other: what happened to you?
13. Can you give more details about the incident?*
Please be as specific as possible.
14. How many offenders were involved?*
- 1 person
- 2-4 people
- 5 people or more
- I don't know the exact number of people involved.
15. Did you know the offender(s)?*
- Yes
- No
- Some of them
- I don't know
- Not disclosed
16. Is/are the offender(s) in a position of power in relation to you (e.g. a police officer, doctor, teacher etc.)?*
- Yes
- No
- I don't know
17. Do you think that the offender(s) was/were under the influence of alcohol or drugs?*
- Yes
- No
- Some of them were
- I don't know
18. Do you think the incident took place due to one or more of the following characteristics applicable to you, or which the offenders believed apply to you?*
- Gender/gender identity
- Gender expression
- Sexual orientation
- Race/ethnicity
- Nationality
- Age
- Disability
- Sex worker
- I don't know
- Other
18.1 Do you think that your appearance at the time of the incident allowed the assumption to be made that you could be trans?
- No
- I try to attract as little attention as possible.
- It depends on my look at a given time.
- I specifically dress in a non-gender typical way.
- I don't make an effort to avoid attention.
- I have physical features that cannot be hidden (e.g. size).
- Yes
More than one answer possible
18.2 Other: which feature may have led to the incident?
19. Why do you think that the incident is connected to the features mentioned above?*
- Because the offender(s) said so.
- The offender(s) knew/thought they knew my sexual orientation or gender identity.
- The incident was preceded by threats or other incidents.
- Because of the place (e.g. a gay bar).
- I don't know.
- Other
19.1 Other
20. Please explain in more detail why you think that the incident was connected to the features mentioned above.

21. Were you physically injured?*
- Yes
- No
- Not applicable
21.1 Can you describe these physical injuries?*
22. Have you experienced any psychological after-effects due to this incident?*
- Yes
- No
- Not applicable
23. Who did you go to for help following this incident?*
- Family
- Friends
- LGBT organisation
- Psychologist/psychiatrist
- LGBT helpline (by telephone or email)
- I didn't seek help.
- Not applicable
- Other
More than one answer possible
23.1 Other: where did you go to for help?

24. Have you reported the incident to the police?*
- Yes
- No
24.1 What reaction did you receive when you reported the incident to the police?*
- Support
- Objective response
- Rejection, condescension
- Ridicule, insults
- Violence
- Other
- I don't know
More than one answer possible
24.2 Other reaction
24.3 Did the police consider the incident a hate crime?*
- Yes
- No
- I don't know
24.4 What were the reasons for not reporting the incident?*
25. Is there anything else you would like to tell us about the incident?

Additional questions
The final six questions are not directly linked to your report, but they are extremely important for our work and for the anti-hate crime campaign. We would therefore be grateful if you could also answer these questions.
26. How many people live at your place of residence (approximately)?*
27. Are you a member of one or more LGBT organisations? (e.g. Pink Cross, LOS, TGNS, Pink Cop, Network, Wybernet, Dialogai, Lestime etc.)*
- Yes
- No
- I prefer not to say
28. What is the highest level of education that you have completed?*
- No education completed
- Primary/secondary school
- Apprenticeship
- Apprenticeship with vocational certificate (Berufsmatura/maturité professionnelle)
- A-level/college (Matura/maturité)
- University degree
- Not applicable
- I prefer not to say
29. What is your current occupation?*
- I am at school (primary/secondary).
- I am doing an apprenticeship.
- I am in employment.
- I am doing military/non-military national service.
- I am studying.
- I am self-employed.
- I am unemployed/looking for work.
- I am retired.
- I am a housewife/house husband.
- Not applicable.
- I prefer not to say.
30. What is you monthly salary?
Net salary after deductions, rounded off to the nearest franc and stated in figures.
31. Contact
Do you want us to contact you about your incident, in order to discuss how to proceed? If so, please provide us your email address or mobile phone number.

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Lesbenorganisation Schweiz
Transgender Network Switzerland
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