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Liberté, Egalité, Fraternité
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Report an incident
A form for reporting any incident related to violation of human rights is below for your kind attention. You may fill it out and send us or in case of need, you may send an e-mail to
incident@diversipedia.org.ua
Date:
1. Personal data of the complainant
Name
Place of location (contact address)
Sex
Age
Nationality
Profession
Country of Origin
Immigration (visa) status in Ukraine (in case of a foreign passport holder or stateless individual)
Telephones
E-mail
2. Against the operation/activity of which body, institution or individual are you complaining?
Choice:
Militia (department №, rayon, city/village, oblast.)
Prosecutor’s office (department №, rayon, city/village,oblast.)
Hospital(department №, rayon, city/village, oblast)
School/Higher educational institutions (name:)
Court/s
Other body/institution
Individual/s (write in details)
Answer:
3. Against which decision, action (or situation) are you complaining? Please present details.
Answer:
4. How would you characterize the offense towards you?
Choice:
Simple Hatred
Xenophobia
Racial discrimination
Anti-Semitism
Religious discrimination
Gender-based racial discrimination
Others (please specify):
5. Why do you think this to be a case of xenophobia or racial discrimination and what would you like to achieve by this complaint? What are your concrete demands?
Answer
6. Did you approach the organization, institution or individual, against which you are complaining, with the idea of conflict resolution?
Answer:
7. In case of racial discrimination: did you undergo any procedures set up for resolution of this conflict? If yes, has the time come for the relevant bodies to deal with this dispute?
Answer:
8. Was the content of your complaint part of a judicial decision or is your complaint currently being considered by the court (sub-judis)?
Answer:
9. Do you agree if this hot line service transfers (refers) your complaint to relevant institutions (national, European or international), if it reaches the conclusion that it is capable of addressing the issue?
Answer:
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None of the fields in this form are obligatory.
None of the fields in this form are obligatory.
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Poll
Will economic crisis cause increase in rate of discrimination in Ukraine?
Yes, it will increase
It will remain unchanged
It will decrease
Difficult to say
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