Incident Report Form (IRF): Step 2

Name*

Prénom Nom

Please select one of the following that applies to you*

Date of incident*

The city where the incident took place*

Type of incident*

Select all that apply to the incident*

Which police service?

Please Specify

(Judge, Lawyer, Member of Parliament)

Occurrence

Number of offenders

Name(s) of offender(s), if known:

About the Victim

Gender*

Age*

Race or ethnicity*

Selecet all that apply.

Do you identify as someone living with a disability?

Address*

Ville Province Code postal

Preferred method of communication

Can we identify ourselves as NCCM when contacting you?*

Have you contacted NCCM in the past regarding another incident?*

How would you like NCCM to serve you?*

Select all that apply

Do you have any supporting documents/photos/audio?

Taille max. des fichiers : 256 MB.

What actions have you taken to date?*

Is there anything else you would like to add to your report?