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Journal Template

I added this form for easy journal writing for your case. Not everybody is skilled in describing incidents. I hope this form would help you to learn how to keep your evidence with logical explanations. What you have to do is copy and past the below. Fill out the form with your experience and you will get a record of your incident eventually.

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Case#:

Date:   /   /       xx:xx am/pm

Place of Incident:

People involved:

(Stalkers you recognized):

What they said:

What they did:

What I said:

What I did:

My role in the incident:

Objects they used (i.e. Cars, T-shirts etc):

Types of harassment:

When and how I figured out their harassment:

Details:

First, I noticed...

Then, I found out...

What I did not understand was...

What I felt strange was...

What I felt funny was...

In normal situation, I think...

I think the purpose of this incident was to...

I think the person who.... has the key role in the incident because...

From now on, I think I should be careful about...

If this happens next time, I think I should...

If this happens next time, I would like to...

I think this incident was (circle one): Very Stressful 5 – 4 – 3 – 2 – 1 OK

To avoid such incident, I think what I need to do is...