Report harassment if you are a student, and it has happened to you

Use this form to report harassment if you are a student, and it has happened to you...

  • You can report anonymously if you choose. This will mean that no one will know who you are.
  • Please write as much as you can remember.
  • If there are tick boxes, you can tick more than one if you wish.
  • When you give us information, it will be sent to the Human Rights Commission. They will study the information. If you have asked for follow-up, you will be contacted promptly by a member of the Safer Students Team.

Information about what happened (the incident)

1. What happened exactly?

How did it start? What did people say? What did they do? What did you do?

2. Why do you think the person was saying or doing hurtful things – what do you think they were thinking?

3. When exactly did it happen?

Can you remember: The time? The day of the week? The date?

4. Where did it happen?

Can you remember: The name of the street? Any names of buildings or shops close by? A letter box number close to you at the time?

5. Vehicles

Was there a car?    Yes      No

If yes, can you remember: What colour it was? The company that made the car? The model of the car? The licence plate number? Even a few numbers from the licence plate can be helpful. Anything else you can remember noticing about the car?

6. People

Please describe the people involved...

For example...

  • What did the person who did it look like?
  • Was the person who did it alone, or was there more than one?
  • How tall or short?
  • How thin or big?
  • What colour eyes and hair?
  • What kind of haircut?
  • What kind of clothes?
  • What colour were the clothes?
  • About how old did they look to you?
  • Any tattoos or piercings?
  • Ethnic background?
  • Is there anything else you noticed about the person or people who did this?

7. Do you know the person, or the people, who did this?

  Yes      No

If you do, you can choose to write their name and contact details here if you wish.

8. Was anyone physically hurt?

  Yes      No

If someone was hurt, what kind of injury? How badly were they hurt?

9. Was any property lost or damaged?

  Yes      No

If so, what was damaged?

10. Do you usually feel safe living in Christchurch?

  Yes      No

General information about you

We need this so that we can understand more about harassment in Christchurch.
This information will not be linked with your name unless you choose to fill in the last section.

11. What is your age group?

 17- 20 years      21-25 years      26-30 years      31-40 years      40+

12.What is your gender?

 Male      Female      Other

13. How long have you been in Christchurch?

 Less than 1 year      1 year      2 years      3 years      More than 3 years

14. What is your first language?

15. I am a student at ...

 CPIT      University of Canterbury      Lincoln University      Other

16. Which nationality and ethnic group do you call yourself?

Your contact details

If you would like to be contacted by someone to follow this incident up, please include the following details.
If you don’t want to be contacted, leave this section.

Name: 
Address: 
Telephone number: 
Email: 
Student number: 

How would you like to be contacted?
(e.g. only at a certain time or place)

I would like to be contacted by: (you may check all boxes)

 University of Canterbury staff
 CPIT staff
 The Human Rights Commission
 Lincoln University staff

When you are contacted, these staff members will not give any information that you tell them to anyone else, or any other organisation, unless you want them to.

 

Report harassment

Saying or doing hurtful things to people because they are different is called harassment. In New Zealand harassment is against the law.

Report harassment if you are a student, and it has happened to you »

Report harassment if you have seen it happen to a student »