Case Report For Trans*

Comment about the questions:

The different types of question require the following types of answer:

a) »only one answer« Please cross only one option!
b) »More than one answer is possible« You may cross more than one option!
c) »(0) – (1) – (2) – (3) – (4)« [Scale value:(0)=zero; (4)=very clear] please cross one scale value!
d) »Open answer – using only a few key words« Please write a short description here.

    1. Part of the questionnaire

    0. Who was the victim of the violent incident?

    0a. victim of the violent incident - other person
    1. How would you categorise the violent incident?

    1a. other category
    1a. Please give a short description of the incident here:
    • The date, time, and for how long the incident lasted,
    • The order of events,
    • In what way did the violence against the person happen, (types of violence? types of Injury?),
    • Please describe the place where the incident took place,
    • Please describe the person(s) who did the violent act(s),
    • If you are not the victim of the violent incident then please describe the victim (e.g. age, where they come from etc.)

    How long did the incident last (from what time to what time)?

    Date:
    Time:

    3. Were weapons used (if so which)

    4. Were there injuries

    4a. If “yes”, who was hurt?

    4b. If “Yes”, what kinds of injuries?

    5. Was anyone else a victim of the incident or in any way affected by it E.g. friends or acquaintances?

    5a. If “Yes” how many?

    6. For how long afterwards were you affected by the incident?

    6a. Other

    7. In which city and neighbourhood/borough did the incident take place?

    7a. If in Berlin, in which Berlin district?

    7b. If not “Berlin” which place?

    (City/County/State/Country)

    8. What was the location of the incident?

    E.g. Street name, post/zip-code, in my/someone’s home, in the Metro/Tube/Subway etc.

    9. Was the incident in your view anti gay/lesbian/trans*?

    9a. If so, how could you recognize the fact that the act was anti-gay?

    10. How many wrongdoers were there (estimate if not known exactly)?

    11. How old were the wrongdoers (estimate if not known exactly)?

    12. Sex of the wrongdoers?

    (Sexes)

    13. Were the wrongdoers known to you?

    13a. Yes, known to me, in particular:

    14. Have you been to the police about the incident and for example filed charges?

    14a. If “No”, which answer best fits your case:

    15. After a violent incident many victims feel partly responsible that the incident happened. Is that the case with you?

    15a. If “Yes”, what reasons do you have for these feelings?

    16. Afterwards, did you have the possibility to speak at length about the incident with someone you could trust?

    16a. If “Yes”, who was it?

    17. If Yes would you say that their support was helpful?

    (0= no help; 4=very helpful)

    18. Do you think that the incident led to a change in your behaviour?

    18a. If no, because...?

    18b. If “Yes”, which of the following best fits your case?

    19. Before the incident had you already been discriminated against, insulted, deliberately annoyed by someone, threatened, injured or robbed?

    Thank you for the information that you entered.

    We would also like you to fill in Part 2 In case you have doubts about answering these questions you can skip them.

    Part 2. – Personal Questions

    20. How would you describe yourself?

    21. How old are you?

    (Age in years)

    22. Are you in a long-term relationship?

    23. What educational qualifications do you have?

    24. Current occupation?

    25. What is the population of your town?

    26. Where is your main residence?

    26a. If “Berlin” what part?

    26b. If not “Berlin” wich place?

    (Local area/City/County/Country)

    27. What is your passport nationality?

    27a. Another nationality

    (e.g. also dual citizenship, then "German and ...")

    28. Are you an active member of one of the following groups?

    29. May we contact you for further questions?

    My first name

    My phone number

    My mail address
    30. Where did you find out about MANEO / Violent Incident Telephone?

    A brief description, e.g. gay magazine, someone told me, ..

    31. Final comments?

    Open answer, use only a few key words



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