HARASSMENT REPORT FORM - GLIFWC

HARASSMENT REPORT FORM

Anishinaabedog of the eleven GLIFWC-member tribes in Minnesota, Wisconsin and Michigan have treatyguaranteed rights to hunt, fish and gather in the territories ceded in 1837, 1842 and 1854. It is illegal to interfere or

attempt to interfere with the exercise of their treaty rights. This type of conduct is punishable by fines, civil damages,

criminal prosecution and other penalties. Examples of illegal interference include stalking, obstructing access to lakes,

shining lights in the eyes of spearers and boat operators to interfere with harvest or prevent safe operation of a boat,

threatening violence and committing acts of violence. This form is intended to create a record so that GLIFWC can keep

track of these incidents and provide appropriate follow-up. Follow-up on certain incidents will involve coordination with

outside agencies. Individuals whose safety or wellbeing has been threatened should immediately report the incident to

local law enforcement, then also to GLIFWC Conservation Enforcement: Mike Soulier 715-209-0093 (Western District

Lieutenant) and Steven Amsler 715-562-0034 (Eastern District Lieutenant).

1. Your name: ________________________________________ Date you completed this report: __________________

2. Phone number(s): ________________________________________________________________________________

3. Physical address (including city, state, ZIP): ___________________________________________________________

_________________________________________________________________________________________________

4. Location of incident: _____________________________________________________________________________

5. Date of incident: _________________

6. Approximate time of incident: ________________

7. Nature of harassment (please check all that apply):

? Unwanted physical contact

? Stalking

? Tampering with or damaging equipment

? Intimidating behavior

? Repeated unwanted words, acts or gestures

? Obstructing access to a location

? Attempting or threatening any of the previous

? Other, please describe: ____________________________________________________________________

8. Was the incident reported to the local law enforcement agency? _____ Yes_____ No (skip to section 9)

If yes, please fill out the following:

Name of agency: ___________________________________________________________________________

Date and time of report: ______________________________________________________________________

Who took the report (name(s) and position(s), if known, otherwise physical description(s)):

_________________________________________________________________________________________

Has there been any follow-up? If so, please describe:

_________________________________________________________________________________________

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Only complete 9-12 if you have not made a report with local law enforcement, and do not intend to:

9. Describe what were you doing when the incident occurred (i.e. were you fishing, hunting, hiking, etc.):

_____________________________________________________________________________________

10. Please describe the alleged perpetrator(s) in as much detail as possible. If known, include their

name(s) and relationship(s) to the location of the incident (i.e. lake property owner, local, tourist, etc.).

Otherwise, include physical description(s) of the alleged perpetrator(s):

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

11. Please describe the incident in as much detail as possible. Include a clear sequence of events and any

specific details that you can recall (continue on a separate sheet of paper, if necessary):

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

12. Witness(es) of incident (include their name(s), if known, otherwise physical description(s)):

_____________________________________________________________________________________

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13. Do you have any audio or video recordings of the incident? _____ Yes

_____ No

If yes, please provide copies to GLIFWC Conservation Enforcement and, if reported, to local law

enforcement.

Give this completed form to a GLIFWC Conservation Enforcement Officer,

or submit via email: harassment@ or fax: 715-682-4221.

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