Racism Report form (E)

Racist discrimination in the region of Basel

Discrimination and violence exist in many forms and there are different ways
to take action against them!
This form offers you the possibility to report discrimination and to receive professional
advice from the office «Stopp Rassismus» (stop racism).

Tick the appropriate boxes:

I’d like to
report an incidentreport an incident and receive advice

I was
directly affected by the incidentwitnessing the incident

When? Date, ev. time of incident:

Where?
institution (e.g. shop, bank)public space (e.g. at park)administration (e.g. tax offices)job search, job marketschool, work placeapartment search, tenancyprivatepolice

What?
discrimination, disadvantagemobbingphysical attackproperty damageinsultsfalse accusationrefusal of services

short description of the incident:

First name:

Family name:

Phone:

e-Mail:

Place:

Date:

Your info is treated confidentially, used in case of consultation.

Δ