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Sample Technology Abuse Log | PDF | Social Science
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Sample Technology Abuse Log

This document provides a sample log for documenting technology-related abuse. The log includes sections to record information about the abuser such as name, contact details, and relationship; descriptions of specific abusive incidents including date, time, details of incident, type of technology involved, and any witnesses; and documentation of reports made to police or medical professionals.

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39 views1 page

Sample Technology Abuse Log

This document provides a sample log for documenting technology-related abuse. The log includes sections to record information about the abuser such as name, contact details, and relationship; descriptions of specific abusive incidents including date, time, details of incident, type of technology involved, and any witnesses; and documentation of reports made to police or medical professionals.

Uploaded by

J
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Sample

Technology Abuse Log

Information About the Abuser


Name of the person abusing or stalking you.

Relationship of that person to you (if relevant).

Contact information of that person
Home address Work address


Phone number(s) Email address(es)


Online account(s), including screen name & type of online account (facebook, etc.)


Other information about the abuser (that might be relevant)


Description of the Abuse
Date: Time:

Describe the event:





Type of technology involved:



Were there any witnesses? What are their names?


Documentation
If you were able to document the abuse, what type of documentation do you have?


Other Information
Did you report it to the police? If so, what is the report number and officer name?

Did you go to the hospital/see a doctor? If so, what was the hospital/doctor name?

Sample Technology Abuse Log ©2014 National Network to End Domestic Violence, Safety Net Project Ÿ TechSafety.org
Supported by US DOJ-OVC Grant # 2011-VF-GX-K016. Opinions, findings, and conclusions or recommendations expressed are
the authors and do not necessarily represent the views of DOJ.

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