File a Report

Use the form below to report an entity for illegal vaccine coercion and/or mandates. Please provide as much information as possible, and ensure that any uploaded source documents are legible and verifiable.

Section 1: Entity Information

Legal Name of Entity *

required

Please ensure this name is correct. If the offence is committed in conjunction with a another entity, please report that entity separately.

Contact Person

optional, recommended

Provide the name of the responsible person, if you know who it is. High-ranking individual, such as the CEO, COO or a Director, but a responsible person in another role may also be provided. We’ll publish their name on the list.

Business Email Address

required without contact number

Please do not provide a personal address, unless it is already available to the public. A public or departmental email addresses may be used when the contact person’s direct email address is not known.

Business Contact Number

required without email address

Do not provide a personal contact number, unless it is already available to the public. A departmental, reception or general phone number may be provided if a direct line for the contact person is not known.

Section 2: Offence and Evidence

In order for an entity to be added to the list, we require evidence or proof of their wrong-doing. This may be provided form of a policy statement (such as a letter or email) or public information that shows how the entity is coercing or promoting vaccination.

Please upload a source document or provide a link to the source below. You may provide both, but a source document is recommended.

Reports that cannot be verified (ie, entity name or logo not present) will not be accepted.

Important Notes:

The Source Document must be a PDF or an image file, and must be legible and verifiable.
This document will be made available to the public on the listing.
However, if the document contains promotional material that proves wrong-doing, we will accept it, but we may not make it available to the public as we don’t promote promotions or their promoters.
If the source document you are providing contains any personally-identifying information (such as personal phone number, identification number or email address), it will be removed from the document.
Unfortunately, we cannot accept or publish source documents containing letters addressed to you or other employees directly, unless you provide explicit consent in the “Additional Information” section at the bottom of this form.

Upload Source Document *

PDF or image file. Maximum 5MB.

Important Notes:

The link you provide must point to a resource that clearly shows the entity’s wrong doing.
If the resource contains promotional material that proves wrong-doing, we will accept it, but we may not make it available to the public as we don’t promote promotions or their promoters.
If we believe that the resource could be taken down at any time, we will provide the resource as a document instead of linking to the original.

Link to Source *

Please do not provide a link to a website home page.

Section 3: Additional Info

If you’d like to provide some additional information about this report, please do so below.

Section 4: Your Contact Info

Once you have submitted your report, we might need contact you to provide more information. Please provide a name and email address we can use to get in touch with you, should the need arise.

Name *

Doesn’t have to be your full name.

Email Address *

Please double check this before sending.

By submitting your report, you acknowledge that you have read, understand the contents of, and agree to our Privacy Policy.

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