Log Form Feedback Phase

We’re survivor-led, and we’re here to:

• Provide survivors of sexual assault who don’t report a safe, anonymous platform to be heard and counted without pressure to report.

• Understand the barriers survivors face to reporting and to seeking medical, mental health, or legal services.

If you are a survivor, we would be grateful for your feedback. 

We’re seeking feedback from 5-7 survivors on our log form to ensure that the questions and language meet survivors’ needs and feel safe to complete.

• No sensitive survivor data will be collected.

• The feedback will be anonymous. 

• All survivor feedback is welcome.

With this feedback, we’ll improve the log form and then pilot it with the LGBTQ+ community in Chicagoland.

The feedback should take about 10-15 minutes to complete. We’re only asking for responses to 5 questions.

1.  Did any question make you feel unsafe? 

2.  Was any question retraumatizing? 

3.  Was any question confusing?

4.  Do you trust that the log form answers will be anonymous? 

5.  Would you recommend this log form to another survivor? 

At the end, an optional text box will be available to share any comments, feedback, and questions.