The Union of the Dispossessed Foundation
Individual Incident Report
Purpose: Record an individual incident accurately for review, possible complaints, and potential litigation.
Write what you know, in your own words. “I do not know” is better than a guess. Preserve details that support or challenge your understanding.
Participant code: ____________________ Date: ____________________
Interviewer: ____________________
□ The participant agrees to have these responses recorded and stored privately for review of this incident and consideration of possible complaints or litigation. Questions may be skipped. The participant can ask the administrator to review or correct the record, or discuss withdrawal.
1. What happened? — the full account
Describe the whole incident in your own words, to the best of your ability. Start just before it began, then explain what happened in order and how it ended. Include your own actions and anything that may not support your interpretation.
What did you personally see, hear, do, or experience? Use exact words only when you remember them; otherwise say that you are paraphrasing.
2. When and where?
Incident date, start and end time, and time zone, if known. Mark estimates clearly. If you do not know, say so.
Exact location or best description. Include the address, nearby landmarks, or online/telephone setting.
When did you first write down or tell someone about this incident? Identify any earlier notes and where the originals are kept.
3. Who was involved?
Your role: directly affected person, witness, or someone recording another person’s account?
Name or description of the ministry, agency, municipality, organization, or service involved. If responsibility is uncertain, say “not confirmed.”
Names, roles, badge or employee numbers, and file/reference numbers, where known and relevant. Explain how you identified each person. Do not guess.
4. Why? — reasons given and your interpretation
What reason did the official or other person give for what happened? Who said it, when, and how?
Why do you believe it happened? Label this as your interpretation and explain which observations or documents support it.
What remains unknown? Are there other explanations or details you are unsure about?
5. Witnesses and information from others
Who else directly saw or heard what happened? Note a name or witness code and a safe way to reach them, if they agree. Contact details can be kept separately.
What did somebody else tell you, as distinct from what you experienced yourself? Identify the source and when they told you.
Let each witness give an independent account in their own words. Do not combine different people’s accounts into a single first-person statement.
6. Evidence and original records
List relevant photographs, video, audio, messages, letters, notices, receipts, medical records, or other documents. Give each item a label (E1, E2, etc.).
For each item: what it shows, who made or obtained it, original date/time if known, when and how you received it, original filename, and where the original is held. Note any edits, crops, conversions, or missing portions.
Identify cameras or other records that might exist and who controls them. Note any request to preserve or obtain a copy.
Attach copies after saving this report. Keep original files and paper records unchanged, with their original metadata where possible. Uploading a copy does not authenticate what it depicts.
7. Effects, losses, and follow-up
What happened to your safety, health, housing, work, property, finances, or access to services? Separate observed effects from suspected causes.
List dates, amounts, damaged or missing items, treatment, and supporting records where relevant. Mark estimates.
What action have you taken? Include complaints, reports, responses, reference numbers, and any deadline stated in a notice. What outcome are you seeking?
8. Review and confirmation
Who gave this account, and who typed or helped record it? Use a participant code if identity is held separately. Note any translation or assistance.
Has the person read this report or had it read back? Record any corrections before marking it completed.
Confirmation: “This is my account to the best of my knowledge and recollection. I have identified estimates, uncertainty, information from others, and my own interpretations.” Record whether the person confirms this and the date/time. A paper copy may be signed and dated.
This is an incident record, not a sworn affidavit or a court filing. Completing it does not itself start a claim, stop a deadline, or guarantee that a court will admit it.
9. Later additions or corrections
For a later change, state what is being added or corrected, why, the source of the new information, and today’s date. Earlier saved revisions are retained. Do not silently rewrite an earlier account.