Free Hate Crime Form - Massachusetts

Massachusetts Hate Crime Reporting Form
Agency Name: Date most recent incident: Revision of previously submitted incident? Y/N ORI: Case # Time (military format) If YES, original case #

Location of incident (use codes on back):______________________ Target of the hate crime (circle all that apply) Bias Indicators (circle all that apply)
1

Person

2 Priv. Prop.

3Public Prop.
2

4

Religious Facility

5

Other, describe Mail Other, describe

1 Spray painted symbols/signs

Verbal harassment Y/N Y/N

3

Dam. to prop

4

5

Indicators of organized Hate Group? (describe in narrative) Prior incidents to this victim/at this location? (describe in narrative) Weapon(s) used? (circle all that apply)
1

Gun

2

Knife

3

Stick /club

4

Rocks /bricks

5

Hands /feet

6

Other, describe

7

None

Specific Bias Type -- CRIME WAS ANTI-____: [Circle all that apply] Race/Ethnicity
11 Anti-Black 12 Anti-White 13 Anti-Asian 14 Anti-Hispanic 15 Anti-Arab 19 Other_______

Religious
21 Anti-Semitic 22 Anti-Catholic 23 Anti-Protestant 24 Anti-Islamic 29 Other:_______

Sexual
41 Anti-Gay(male) 42 Anti-Lesbian 49 Other________

Handicap
51 Anti-Mental 52 Anti-Physical 53 Anti-AIDS 59 61 62

Gender Anti-Male Anti-Female

Other_______

Information about the Victim(s) and Offender(s) Victim #1 #2 #3 Age Race Sex M/F M/F M/F Inj Perp #1 #2 #3 Age Race Sex M/F M/F M/F Arrest made Y/N Y/N Y/N Court order/injunction Y/N Y/N Y/N

If other victims, TOTAL number:__________

If other preps, TOTAL number_____________

Criminal Offenses that occurred during the Hate Crime (check all that apply)
1

Vandalism Threats Simple Assault Rape

2

Damage Rel. Obj Property Damage Larceny/theft Manslaughter

3

Harassment Weapons Offense Burglary Murder

4

Disorderly Person Sex. Offense Agg. Assault Gen. Civil Rights

5

Trespass Arson Robbery

6

7

8

9

10

11

12

13

14

15

16

17

18

19

Narrative: (attach additional sheets as necessary)

If Nothing To Report (ZERO REPORT), for the Month of:_______, 199__
Filled out by:____________________________ Chief's signature:_______________________________
Revised10/94

Instructions and Definitions
Hate crimes are any crime principally motivated by hatred of another because of race, religion, ethnicity, sexual orientation, handicap status, or gender. All hate crimes would still be crimes even if the bias motivation were absent. They have the added element of choosing a victim because of bias against the victim. Any criminal action motivated by bias should be recorded on the Hate Crime Reporting Form. Situation
Agency: Agency Case #: Date most recent inc: Time: Revision of prev. report Location The name of the organization submitting the form. The case number assigned by the reporting agency. The date the incident occurred (to closest day) or the most recent incident if one of a series. Time of the event (to nearest hour or minute) using a 24 hour notation. If this is a revised report, indicate here, and note the original case number (if different) 1-air/bus/train term. 2-bank/saving&loan 3-Bar/night club 4-church/synagogue/temple 5-commercial/office bldg 6-construction site 7-convenience store 8-department/discount store 9-drug store/doctor's office/hospital 10-field/woods/park 11-government/public bldg 12-grocery/supermarket 13-highway/road/alley 14-hotel/motel 15-jail/prison 16-lake/waterway 17-liquor store 18-parking lot/garage 19-rental storage facility 20- residence/home 21-restaurant 22-school/college 23-service/gas station 24-specialty store 25-other/unknown Target of incident: Check principal target. Bias Indicators: Check all that apply. Organized Hate Group: Check Yes if any of the following apply: printed literature, patches or uniforms used, or other indicators of an organized group present. Describe in narrative Prior incidents If other bias crimes have occurred to this victim or at this location, indicate the total number. Check all that apply. Weapon(s) Used: Crime Motivation: Check apparent motivation(s), that is, was crime motivated by racial, religious, or other bias. Check all that apply.

Victim(s) and Offender(s)
Age: Race/Ethnicity: Code to nearest year or use best estimate. Use the following codes W (white), B (black), H (Hispanic, Latin American, or Spanish Surname), A (Asian: including Chinese, Japanese, Korean, Vietnamese, Cambodian, Other Southeast Asian, or Pacific Islander), O (Other: any other not classifiable) U (unknown). Sex: Circle code letter: M (male) F (female) Physical Injury: Code the most serious category. Use the following codes: 1. Apparent broken bones 2. Possible internal injuries 3. Severe lacerations 4. Other major injuries 5. Other minor injuries 6. None visible Arrest/Summons: Check if arrest made or summons sought. Court Order: Check if court or injunction sought or issued. Other crimes committed:Check all that apply. Narrative: Use this to provide clarifying details or explanations. Attach additional sheets as necessary

Zero Reporting:
If your agency had NO Hate Crimes in this month, indicate the month and year which had zero hate crimes; sign, date, and submit form Signature and date: Agency head should SIGN the report, and the date of the report filled out

This Hate Crime reporting form should be submitted along with any other routine UCR submissions to: : Crime Reporting Unit Massachusetts State Police 470 Worcester Road Framingham, MA 01701
Form CRU-2, rev 11/94 J:\DESKTOP\MYFILES\FORMS\HATECR.FRM