ACT Policing: Reporting historic sexual assault

Disclaimer: This online form is only for sexual assaults that occurred more than six months ago.

If you have been sexually assaulted, we encourage you to call police on 131 444, or visit a police station or hospital so your safety and health can be assessed as soon as possible.

Both the Canberra and Calvary Hospital provide support for all victims of sexual assault and provide emergency treatment. They will also connect you with support services such as Forensic and Medical Sexual Assault Care (FAMSAC) who can administer preventative medical care against Human Immunodeficiency Virus (HIV) sexually transmitted infections (STIs) and unwanted pregnancies.

Reporting sexual assault can be a daunting and traumatic experience for victims and we recognise the emotional hardship and courage involved in coming forward.

ACT Policing's Sexual Assault and Child Abuse Team (SACAT) are a specialised team that are dedicated to investigating sexual assault committed against adults and children. Their priority is ensuring the safety and wellbeing, both mentally and physically, of victims and survivors of sexual assault.

ACT Policing work closely with the Canberra Rape Crisis Centre (CRCC) who provide confidential counselling services free of charge and can assist you with attending hospital, provide advice and support through criminal justice proceedings and refer you to practitioners to assist in your recovery.

Once you submit this form you will be contacted by a member of ACT Policing, if you have provided your consent, who can talk you through what is involved if you decide to proceed with a police investigation. They can also discuss alternate options, including making an Information Report which is for intelligence purposes only.

This form is for reporting sexual assaults that occurred within the Australian Capital Territory (ACT). If the offence occurred in another state, please contact the police in the state the offence occurred.

If you are assisting a victim to complete this form, please be mindful you only use the exact words provided by the victim.

Please note it is an offence to make a report that contains information or allegations that are knowingly false or misleading.

View more information on sexual assault

Your privacy
ACT Policing use this form to collect information which is necessary to provide services to victims of sexual assault including adults and children in accordance with the Information Privacy Act 2014. More information can be found on our website under privacy policy .

Please note, if you choose to have this report investigated, the information you provide must be true and accurate to the best of your knowledge. The evidence provided in your report will form the basis of any investigation and will be disclosable in court proceedings if the matter proceeds through the judicial process.

Report form

First name of person completing the form *

Last name of person completing the form *

Victim’s name (if different to the person completing the form)

Victim’s contact number *

Victim’s email address * A copy of your report will be sent to this email address

Victim’s email address (please repeat) *

Victim’s address *

Victim’s date of birth *

Day Month Year

Does the victim consent to being contacted by ACT Policing? *

Does the victim consent to being contacted by the Canberra Rape Crisis Centre? *

If the victim consents to being contacted, preferred contact method

Email
Phone

If the victim consents to being contacted, preferred contact time

Anytime
Morning
Afternoon
Evening

Sexual assault details - Please provide details of the sexual assault in as much detail as possible. If you can’t remember, please do not guess.

What happened? Describe the sequence of events from beginning to end.

Where did it happen? Describe the location of the sexual assault, noting any details such as land marks or signage.

When did it happen? Please note the day, date and time of the sexual assault/s as accurately as you can and the length of time of the attack.

Who was present? Describe everyone that was present during the sexual assault including the offender/s and witnesses.

What was said? Was there any dialogue exchanged between the people involved? Describe the conversations as accurately and completely as possible.

Were any vehicles involved? Please describe the vehicle’s make, model, colour, number plate if you can.

Was anything stolen or damaged? Please describe any items that were taken during the assault.

Were there any injuries? Please describe any injuries sustained during the sexual assault (visible and non-visible).

Were any weapons involved? Please describe any weapons used in the sexual assault (sighted or threatened without seeing the weapon).

Were police or other authorities called? Can you recall the names or identification numbers of the authorities that attended? Were you given a report number?

Discussions about the event Did you discuss the event with anyone? If so, who did you discuss the event with and what did you discuss?

After effects of the sexual assault How has the event made you feel?

Other information

Is there anything else you would like to include?

Acknowledgement

Acknowledgement * I acknowledge that any statements made by me in this report accurately set out the evidence which I would be prepared, if necessary, to give in court as a witness. Any such statement is true to the best of my knowledge and belief, and I make it knowing that, if it is tended in evidence, I shall be liable to prosecution if I have wilfully stated anything which I know to be false, or do not believe to be true.

I agree