1. Location & Timing:

Exact date of the incident:

Approximate time the incident began:

Approximate time it ended:

City / Area:

Location type:
(your incall, client’s place, car date, hotel, street, online-to-meetup, agency booking, etc.)

Specific neighbourhood, intersection, or building:

Room number or floor (if hotel/apartment, optional):

Was the area isolated or busy?

Was lighting poor or good?

2. Client Physical Description

Estimated age:

Gender:

Height:

Weight/build (thin, average, muscular, heavyset, etc.):

Skin tone:

Ethnicity:
(if comfortable sharing)

Hair colour, texture, and length:

Facial hair (type, length):

Eye colour:

Any visible tattoos:
(describe location + design)

Scars or marks:

Piercings:

Teeth or smile description:

Voice:
(accent, tone, noticeable speech pattern)

Smell:
(cologne, cigarettes, alcohol)

Overall impression of client:
(clean, intoxicated, agitated, nervous, calm, etc.)

3. Clothing Description

What were they wearing when you met?

Jacket/coat description:

Footwear:

Headwear:
(hat, hood, cap)

Did they change clothing during the date?

4. Vehicle Information (if applicable)

Vehicle type:

Make:

Model:

Colour:

Year (approx.):

License plate (full or partial):

Province/state of plate:

Condition:
(dirty, damaged, dents, missing hubcap)

Unique identifiers:
(stickers, tinted windows, rims, decals)

Location where the vehicle was parked or picked you up:

5. Booking / Contact Details

Name or alias they provided:

Phone number used (texted/called):

Any additional numbers they used:

Email used:

Social media or platform used:
(website, app, ad site, agency)

Did they contact you through multiple accounts?

Did they refuse to give info or avoid basic screening?

6. Behaviours Before the Meeting

What did their initial messages sound like?

Did they use respectful language?

Did they try to negotiate beyond your limits?

Red flags during booking:
(rushing, asking for unsafe services, being pushy)

Did they refuse screening info?

Did they try to change the plan last-minute?

Did they try to avoid providing pickup location or room number until the last minute?

7. What Happened During the Incident

Describe what made this a “bad date.”

Did the client become aggressive verbally?

Become physically aggressive?

Corner you or block your exit?

Insist on unsafe services?

Remove or tamper with condoms?

Attempt stealthing?

Attempt to not pay, underpay, or switch money?

Try to extend time without paying?

Film or take photos without consent?

Refuse to stop filming?

Demand personal info?

Steal items?

Damage your property?

Bring in additional people unexpectedly?

Were weapons mentioned or shown?

Was the client under the influence (drugs/alcohol)?

Did they show signs of drug psychosis?

Did they threaten self-harm or try to emotionally manipulate you?

8. Environment Safety Details

Did locks work properly?

Were windows or exits blocked?

Did the client try to disconnect your phone or move your belongings?

Were you able to leave safely?

Did anyone outside hear or see the situation?

9. After the Incident

Did the client follow or stalk you afterwards?

Continued unwanted messages or calls?

Harassment online or through fake accounts?

Attempts to expose you or find personal info?

Did they return to the same work area?

Did they threaten retaliation:
(reviews, gossip, reporting)

10. Impact on You (Optional)

Were you physically injured?

Did you need medical care?

Were you emotionally distressed or scared?

Did you contact a support service or bad date line?

Did you file a police report?:
(Yes / No / Prefer not to say)

11. Items / Money Lost

Money refused or stolen:

Personal items stolen:
(phone, wallet, clothing, work tools)

Damage to your property:
(car, phone, hotel room, door)

12. Red Flags & Warnings for Other Workers

What should others look out for?

Behaviour pattern:
(e.g., manipulative, pushy, angry quickly)

Key phrases they used that might be recognizable:

Any tricks they used:
(fake e-transfers, fake screenshots, overpayment scams, bait-and-switch tactics)

13. Consent for Sharing

Do you give permission for this report to be shared with other workers?

Local bad date lists?

Outreach services?

Police (optional)?

Do you want to stay anonymous?

14. Optional Worker Info

Name/working name (optional):

Best way to contact you if follow-up is needed (optional):

✅ Submit Button

⚠️ Reviewed within 24/48 Hours after Form Submission.

⚠️ Submitting this report does not replace emergency services. If you are in immediate danger, call 911 or your local emergency line.