Confidentiality

The Crime Reporting Unit, in conjunction with the Criminal History Systems Board, shall assure that no disclosure of Criminal Offenders Record Information subject to M.G.L. c. 6, §§ 167 through 178 is made otherwise than in accordance with the provisions of said statute. Names of victims and perpetrators of hate crimes shouldnot bereported to the Crime Reporting Unit on the prescribed form, in the course of the hate crimes data reporting. Crimes shall be referenced and identified by the case number assigned by the reporting agency, the time and date of the incident, and other particularized information. EXHIBIT A MASSACHUSETTS HATE CRIME REPORTING FORM Agency Name: ORI:__________ Case # Date most recent incident:________ Time (military format)__________ Revision of previously submitted report? ___Yes ___No If YES, original case#:______________ Location of offense: ___________ Target of Hate Crimes: (circle all that apply) 1-Person(s) 2-Private Property 3-Public Property 4-Religious facility 5-Other, describe:________________ Bias Indicators (circle all that apply) 1–Spray painted Hate symbols/language 2-Verbal harassment/slurs 3-Damage to prop 4-Threatening mail 5-other, describe:__________ Indication of Organized Hate Group? ___Yes ___No (describe in narrative) Prior bias incidents to this victim at this location? ___Yes ___No (describe in narrative) Weapon Used: (circle all that apply): 1-Gun 2-Knife/cutting 3-Stick/club 4-Rocks/bricks 5-Hands/feet 6-Other__________ 7-None C Race/Eth check Religious check Sexual check Handicap check Gender check 11 Black 21 Jewish 41 Gay(male) 51 M ental 61 Male 12 White 22 Catholic 42 Lesbian 52 Physical 62 Female 13 Asian 23 Protestant 43 Other___ 52 AIDS 63 Anti- Transgender 14 Hispanic 24 Islamic 53 Other___ 15 Arab 25 Other___ 16 Other___ heck all that apply Victim Age Race Sex Inj Perp Age Race S ex Arrest? Court order or injunction granted No #1 M /F No #1 M /F Y/N No #2 M /F No #2 M /F Y/N No #3 M /F No #3 M /F Y/N If other victims, total #__________ If other perps, total #____________ C Vandalism Damage Relig Obj Harassment Disorderly Person Trespass Threats Property Damage Weapons Offense Sex Offenses 10 Arson 11 Simple Assault 12 Larceny Theft 13 Burglary 14 Aggravated Assault 15 Robbery hec Rape k all that apply 17 Manslaughter 18 Murder General Civil Rights Narrative (attach additional sheets as necessary ) Filed out by:_________________________ IF ZERO REPORTS, CHECK:______ Chief’s signature:_____________ Date:______ EXHIBIT B