COVID-19 Racism in Canada Incident Reporting
In Canada, xenophobia and racism toward Chinese and other Asian communities have been on a rapid rise since the outbreak of the COVID19.

To confront that racism we need to make our voices and experiences heard. If you have faced discrimination violence and racism as a result of COVID19 please considering filling out this form so that we have a record of you experience.

This is a national project in partnership with several other organizations. We welcome submissions from across Canada.

Individual information, including personal identification details, will be kept confidential. We will not share your identifying information without your permission. We will use the collected experiences to better support our anti-racism advocacy work, and to communicate the shared concerns of discrimination held by Chinese Canadian and other Asian Canadian communities in relation to the pandemic.

Please complete the form for EACH SINGLE incident that you have encountered.

This project is funded by the Department of Canadian Heritage, Government of Canada.
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1. Did this incident happen to you or were you a witness? *
If this did not happen to you, please complete the following questions to the best of your knowledge of the individual who experienced the incident of racism and discrimination.
2. Age *
3. Gender *
4. Province or Territory *
5. City or Town *
6. What racial group, or racial groups, do you feel you belong to? (Check all that apply) *
Required
7. Date of Incident *
MM
/
DD
/
YYYY
8. Time of Incident *
9. Where did the incident occur? *
10. Location of Incident (e.g. address, main streets and intersection, etc.)
11. Type of Discrimination (Check all that apply) *
Required
12. Suspected Reason for COVID-19 Discrimination (Check all that apply) *
Required
13. Description of Incident (Please provide 2-3 sentences describing the incident)
14. What injury, harm or other impact resulted from the incident? (Check all that apply) *
Required
15. Did you report this incident to: police, human rights commission, management of the company, government, politicians, media, etc.? (Check all that apply). If none of the options apply, please explain in "Other." *
Required
16. Has this incident been reported to the media or posted on social media? *
17. If you answered yes to the above question, please provide links, photos, news clips, social media posts, etc. of the incident. For photos or attachments, if you are willing, please email them to us at info@ccnctoronto.ca.
18. What result would you like to see from sharing your experience? (Check all that apply) *
Required
19. Do you consent to our organization contacting you based on what you have shared? (Note: This is just permission to contact you. This is NOT permission to publicize your identity) *
20. Your name
21. Your email address
22. How did you find out about this online reporting web page? *
Required
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