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Report Form

Information entered into this form may be forwarded to law enforcement for investigation and review.

What type of Incident are you reporting? required
Date and Time of incident required
Month
Day
Year
Hour : Min. :
Time zone
Your Age required
Where was the information located? required

Recently Reported Email Messages

Please check if the subject line of the email spam you wish to report is listed below. If so, click on the matching subject line of the message you received. Otherwise, check the box below the subjects to continue filing out a new report.

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The message I received is not on the above list.
Subject
Expanded Headers
Description
URL
Website Description
Please enter website URL above, do not enter it into the description field.
Newsgroup Name
Author
Article
Subject
Date
Description
Chatroom Description
Website Address
Screen Name/Username
ICQ#
IP Address
Suspect's Email
Description
P2P Program
Title of file being shared
User's name or IP address
Club/Group/Community Description
Website Address
Would you provide us with contact information? Yes No
Name (First, Initial, Last)   
Address
City
Province/State
Postal/Zip Code -
Country
Phone Number () - ext.
Additional Phone Number () - ext.
Time Available for Call Back (if necessary)
Email Address
Relationship to Child Victim (if applicable)
Do you know the Child Victim? Yes No

Child Victim Details

Name (First, Initial, Last)   
Address
City
Province/State
Postal/Zip Code -
Country
Child's Email Address
Child's Date of Birth
Child's Approximate Age
If there were other children involved in the incident, please describe in section below.
Do you know the Suspect? Yes No

Suspect Details

Name (First, Initial, Last)   
Address
City
Province/State
Postal/Zip Code -
Country
Suspect's Email Address
Suspect's IP Address
Suspect's Approximate Age
Relationship to Suspect
If there were other suspects involved in the incident, please describe in section below.
Has the incident been reported to law enforcement? Yes No

Law Enforcement Details

Agency Name
Officer's Name (First, Last)  
Officer's Phone Number () - ext.
Has this incident been reported to another Agency/Tipline? Yes No

Other Agency/Tipline Details

Agency Name
Tipline
Date Reported

If you know about a child who is in immediate danger or risk, call 911, your local police, or Cybertip.ca's toll free line at 1-866-658-9022.
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