STALKING INCIDENT LOG


Victim Information
Name of victim (your name):
Gender:
Date of Birth:
Address:
Telephone numbers including home, work and mobile:
Email address:
Aboriginality or Ethnicity:
Language spoken:
Occupation:
Do you have a current Apprehended Domestic Violence Order?: Yes or
No

Offender Information (if possible provide police with a photo of the
offender)
Name of offender:
Nicknames, aliases, street names:
Gender of Offender:
Date of Birth:
Address:
Other addresses where the offender might be located:
Telephone numbers including home, work and mobile if known:
Email address if known:
Aboriginality or Ethnicity:
Language spoken:

Offender’s occupation:
Offender’s employer:
Employer’s address:
Employer’s telephone number:

Car details if known (including registration number, colour, model,
type):

Does he or she have a weapon, and if so what type? Yes or No

Is the person licensed to carry a firearm? Yes or No

Do you know if the person is subject to an Apprehended Violence Order?
Yes or No

Do you know if he or she has been arrested in the past? Yes or No

If yes, what was he or she arrested for?

Record each individual incident of stalking as follows:

INCIDENT No. 1:

Date:
Time:
Location:

Hi Peter,
Regarding your stalker, here is a form to fill out:

Regards
Nerelle.


Witnesses if any:
Witnesses contact details if known (including phone numbers):

Description of the incident (what happened):

Messages, emails, faxes, letters, items left for you (keep all of
these – the police may be able to use them as evidence):

Reported to police at (name of police station):

Name of police officer reported to:

Date reported to police:

Police event number (if known):

Record each seperate stalking incident using the above format (i.e.
Incident No 2:, Incident No 3: etc)