Public Safety

Anonymous Sexual Assualt Report


Date of Assault:   Time:

Place of Occurrence:
An address is preferred, but if it occurred at the victim's home, a team area, part of town or street, coordinates are acceptable.


Name/Nickname:  Age:


Physical Description/Distinguishing Characteristics:
Include odors, scars, tattoos, facial hair. speech impediments, etc.

Suspect/Victim Relationship:                           Type of Coercion/Force:
 Partner/Lover                                                    Verbal
 Ex-Partner/Lover                                              Physical
 Spouse                                                                Threat of Death
 Colleague/Co-worker                                      Presence of a Weapon:  Yes No
 Acquaintance                                                      If Yes, what type:
 Met Same Day-Socially                                   Incapacitation by Drugs or Alcohol:  Yes  No
 Met Same Day-Non Socially                            If Yes, what type:
 Stranger                                                             Other Coercion/Force:

Were you physically injured?  Yes  No
If yes, please describe the extent and nature of your injuries in detail:

Nature of Assault:                                                   Place of Occurrence:
 Attempted                                                              Victim's Home
 Completed                                                             Suspect's Home
 Vaginal                                                                   Unknown Home
 Oral                                                                         Hike/Bike Trail
 Anal                                                                        Car/Vehicle
                                                                                     Parking Lot

Manner of initial contact:
Came to victim's door, attacked on street. etc.   

What did the suspect say before, during and after the assault?
Please be as specific as possible  

Do you plan to make a formal report to the police?  Yes  No  Not Sure
If not Yes, why have you chosen to make an anonymous report rather than make a formal report to the police?

Please give a narrative of the sexual assault:
Please provide as much information as possible