Rideshare Harassment Incident Report Form
Please use this form to confidentially report a harassment incident that occurred during a rideshare trip. All questions are focused on gathering clear details to help our team review and address your report.
Date of Incident
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Location of Incident
*
Rideshare Company
*
Please Select
Uber
Lyft
Bolt
Ola
Other
Your Role in the Incident
*
Rider
Driver
Other
Role of Other Party Involved
*
Rider
Driver
Other
Type of Harassment
*
Verbal
Physical
Sexual
Discriminatory
Other
Please describe the incident in detail
*
Trip Details (e.g., pickup/dropoff location, approximate time, vehicle description)
Were there any witnesses?
Yes
No
Not Sure
Upload any supporting evidence (optional)
Upload a File
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of
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