REPORT A DISCRIMINATION CASE

Contact and reporting details

Fill in your identifying details and choose whether you want to submit the report anonymously. If you remain anonymous, contact fields become optional.

I want to remain anonymous

Personal data becomes optional.

Full name

Email address

Phone

Your role in this report

Incident context

Describe where and when the situation occurred, in what capacity you are submitting the report, and which circumstances are relevant for assessing the case.

City / County

Date of the incident

Medical unit / institution involved

Have you previously reported the matter to the institution involved or another authority?

If yes, specify which one and when

Detailed description of the situation

Consequences for the affected person

Available evidence

Check the types of evidence you already have and mention any other materials or information useful for the review.

Type of support requested

Indicate what kind of support you need from the SASTIPEN team for the next steps.

Declaration and data protection

Confirm the accuracy of the information provided and your explicit consent for processing the data, including any special categories of data you choose to include, for the purpose of reviewing the report.

I declare that the information provided is true to the best of my knowledge.

I give my explicit consent to the processing of my personal data and, where applicable, the special categories of data I choose to include in this report, including health data or information that may reveal ethnic origin, for the purpose of reviewing the report, in accordance with Regulation (EU) 2016/679 (GDPR).

Before you send

This form may contain sensitive data and is intended for case assessment, guidance toward competent institutions, and, where necessary, preparation of administrative or legal follow-up.

Required fields are necessary to register and review the report. If you report anonymously, the team may have limited ability to request additional clarifications.
Submit only the data that is strictly necessary. If you report on behalf of another person, you should have a legitimate basis to provide the data or anonymize information that is not needed.
Resolved reports may be archived after at least 180 days of inactivity and scheduled for deletion 365 days after archival, unless the law or the defence of legal claims requires longer retention.
You may withdraw consent at any time, without affecting the lawfulness of processing carried out before withdrawal. Withdrawal may nevertheless limit our ability to continue reviewing the case.

See: GDPR policy · Protection policy · Terms and conditions