Violation Report Form

 Incident Date:

 Abuse Category:Select OneDEMOCRACYWOMEN RIGHTSMINORITY RIGHTSCHILDREN RIGHTSCIVIL AND POLITICAL RIGHTSECONOMIC SOCIAL AND CULTURAL RIGHTS

 Abuse Subcategory:Select OneDEMOCRACYRule of LawSeparation of PowersFree and Fair ElectionsPublic Transparency and AccountabilityCIVIL AND POLITICAL RIGHTSDeath ThreatsArbitrary ExecutionForced DisappearanceFair Judicial ProceedingsArbitrary Arrest and DetentionTorture and Inhuman TreatmentFreedom of Opinion and ExpressionFreedom of Association and AssemblyPrison Conditions and Prisoners RightsECONOMIC AND SOCIAL RIGHTSRight to FoodRight to HousingRight to EducationRight to HealthcareRight to a Good EnvironmentRight to Good Work ConditionWOMEN RIGHTSDivorceCustodyInheritanceDiscriminationForced MarriageFemale Genital MutilationCHILDREN RIGHTSChild LaborChild MarriageJuvenile JusticeFemale Genital MutilationMINORITY RIGHTSPrejudiceRight to Way of LivingProtection of Environment

 Name of Abuse Victim:

 Contact of Abuse Victim:

 Name of Abuse Perpetrator:

 Contact of Abuse Perpetrator:

 Name of Person Reporting Abuse:

 Contact of Person Reporting Abuse:

 City/Town Where Incident Occurred:

 Province/Region Where Incident Occurred:Select OneEASTWESTNORTHSOUTHCENTRELITTORALADAMAWAFAR NORTHSOUTH WESTNORTH WEST

 Detailed and Chronological Description of Incident: