Privately Document and Timestamp an Incident

This is where you can privately detail, document, and timestamp incidents of abuse, assault, harassment, and misconduct as you see fit and optionally receive alerts if someone else names your same abuser.

Some things to know:

  • You are not reporting anything to anyone or authorities. 
  • This is a private and personal tool for you to detail incidents with a timestamp that you can use as evidence at any later date when or if you decide you do want to come forward.
  • All of your information is secure, safe, and encrypted.
  • None of the information that you provide will ever be shared without your expressed and thoroughly vetted permission.
  • This service is free and independent of any industry.
  • Our forms are HIPAA compliant and mobile friendly.
  • Receiving perpetrator matching alerts is OPTIONAL and you can opt out at any time.
  • You are not alone.

Step 1: Detail Your Incident

Fill out the encrypted incident form below with as little or as much information you prefer about how and when your experience occurred and who was responsible.  We recommend providing as much detail as possible, no matter how small. Research shows that trauma scrambles memory, so it's good to have the record of your own account. But also, every detail matters in evidence if you come forward at a later date.

Step 2: Submit Your Incident Form

Carefully review all information you've provided before submitting. Once you hit submit, your form can not be changed. This is to protect your timestamped evidence. If you have any changes or more information, you will have to submit a second form detailing the additions. 

In order to submit, you will be asked to enter your name and driver’s license number for verification and (if necessary in the future) possible vetting purposes. This is for your safety and protection because no one will ever be able to request your information without going through an attorney who has vetted your identity thoroughly. Your information will never be used, posted, or shared absent a court order.

When you are comfortable with your form, hit submit. 

Step 3: Verify Your Submission

Check your email to confirm you've received a redacted copy of your form.
From here, you can:

  • Print it and keep it filed for future reference if that feels safe 
  • Keep it filed in your email for future reference 
  • Delete it if it doesn't feel safe to keep the record. 

If you did not receive an email, email us.  

Step 4: Follow Up & Optional Alerts

Rest assured that your information is secure and encrypted and you now have a timestamped piece of evidence to show at any later date complete with the details as you recall. A timestamped report of sexual misconduct or discrimination can be a critical piece of evidence should you ever choose to press charges or file a civil suit against your abuser.

You will be able to request a copy of your timestamped submission at any later date, but know it will only be provided after you're able to verify your identity through the name and driver's license number on the report that you provided.

If you opted to be notified with matching perpetrator alerts, we will email you with a a code and instructions of how to continue. You can choose to ignore this code and request to be removed from alerts at any time if you change your mind. 

If you are having trouble submitting your incident report and would like help, contact us and someone from our staff will get back to you promptly.

"*" indicates required fields

You Name*
This field is for validation purposes and should be left unchanged.