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Instructions: Please be objective as any evidence of partisan
bias in your report may undermine our credibility. Provide as many
factual details as possible about the events relevant to this incident.
Be sure to indicate whether the information you are reporting was
heard or seen directly by you or not.
1. What was the nature of the incident? (Circle one or more of
the listed options)
a) Violence (Physical attack or destruction of property)
b) Intimidation (Threats of violence or other kinds of pressure)
c) Harassment (Chanting or shouting or taunting at voters)
d) Improper voting or counting procedures
e) Material (Insufficient ballot paper, etc)
f) Other………………………………………………………………………………………………
2. Provide a brief factual description of the incident, including:
a) Who was involved and their positions and affiliation ………………………………………………………………………………………………………
…………………………………………………………………………………………………… ..
b) Where exactly did the incident occur? Please describe the sequence
of events. (Attach additional paper if necessary).
……………………………………………………………………………………………………… .
……………………………………………………………………………………………………… .
……………………………………………………………………………………………………… .
……………………………………………………………………………………………………… .
3. Who was/were the victims(s) of the incident?
a) Political Party (specify)………………………………………………………………………
b) SecurityAgent (specify) …………………………………………………………………….
c) Voter……………………………………………………………………………………………….
d) Other………………………………………………………………………………………………
4. How many votes do you estimate were affected by the incidence,
if any?…………………..
Explain the basis of your estimate………………………………………………………………..
…………………………………………………………………………………………………………………
Did you count the number of disputed ballots?………………………………………………
5. Name the Election Officer who was informed………………………………………………..
6. Name three witnesses to the incident:
a) ………………………………………………………………………
b) ………………………………………………………………………
c) ………………………………………………………………………
Observer’s Signature ……………………………..
Date……………………………………………………..
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