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LGBTQIA+ SERVICES AT POLICE STATION SURVEY
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* Indicates required question
NAME OF POLICE STATION:
*
Your answer
LOCATION:
*
Your answer
NAME OF POLICE OFFICER:
*
Your answer
DATE:
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MM
/
DD
/
YYYY
CASE NO:
Your answer
1.
Did the police officers at this police station treat you with respect when reporting your case?
*
Yes
No
Maybe
Other:
2.
Were you treated with dignity when reporting being physically assaulted by a sexual partner as a member of the LGBTQIA+?
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Yes
No
Maybe
Other:
3.
Have you experienced any bad service at police station because you are LGBTQIA+?
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Yes
No
Maybe
Other:
4.
What suggestion do you have for this police station to improve their services?
*
Your answer
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