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VIOLATION SUBMISSION FORM
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Incident Title
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Incident Description
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Location - Region
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Date of Incident
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Type of Incident
Access to Water
Air Pollution
Forced Relocation
Child Labour
Land Rights
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Affected Groups
Community
Youth
Women
Farmers
Human Rights Defenders
Indigenous Peoples
Children
Workers
Media and Journalists
Religious Leaders
Elderly
Fisherfolk
Local Businesses
Landowners
Civil Society Organizations (CSOs)
Environmental Activists
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Company Name
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Company Type
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Local
Foreign Multinational
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Associated Minerals
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Gold
Bauxite
Manganese
Diamond
Limestone
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Company’s Response
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Actions Taken by Affected Groups
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Actions Taken by Companies
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Actions Taken by Duty Bearers
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Progress or Results
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Photos or Videos
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Document Attachments
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Reported By
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Phone
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