Hate Incident Report Form

If you are trying to report a business for failing to comply with COVID-19 health orders, please contact the LA County Public Health - Environmental Health Department at 888-700-9995 to make your report.

Or if you are in the City of Los Angeles, you can submit a report on their City of Los Angeles - Complaint Intake Form for Alleged Businesses in Violation of the Safer at Home Order

Incident Data

Online (Select all that apply)
Types of Crime or Harassment (Select all that apply)
Motivation for Crime or Harassment (Select one)
Action Taken - Who else has this incident been reported to? (Select all that apply)

Victim Information

Victim Information - Individual

Victim's Race (Select all that apply)

Victim Information - Group

Age Range of Group Victimized (Select all that apply)
Race Composition of Group Victimized (Select all that apply)
Gender Composition of Group Victimized (Select all that apply)

Perpetrator Information

Perpetrator - Individual

Race of Perpetrator (Select all that apply)

Perpetrator - Group

Ages of Perpetrators in Group (Select all that apply)
Gender of Perpetrators in Group (Select all that apply)
Race of Perpetrators in Group (Select all that apply)