BRACE

Report Form for Mining Infractions and Human Rights Abuses

Use this form to document a mining-related infraction or human rights abuse. You may fill it in online and submit through our Submit a Violation Report wizard, or print/save this page as a PDF to complete and submit by hand.

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Report Form for Mining Infractions and Human Rights Abuses

Contact Information (Optional)

You may choose to remain anonymous. However, providing your contact details will allow us to follow up with you for additional information if necessary.

Name
 
Address
 
Town/City
 
Country/Region
 
Tel No
 
Email Address
 
Age
 
Gender
 
Position Held/Responsibilities in the Community (if any)
 

Complaint Details

1. Nature of Mining Activity (check all that apply)

  • Large Scale Mining
  • Small Scale Mining
  • Illegal Mining/Galamsey

2. Name of Mining Company

 

3. Location of the Mining Activity

 

District/Region

 

4. Description of the Issue (check all that apply)

  • Water pollution
  • Air pollution
  • Land degradation
  • Deforestation
  • Noise pollution
  • Displacement of communities
  • Health impacts on community members
  • Human rights abuses
  • Violation of labor rights
  • Destruction of cultural or historical sites
  • Improper waste disposal
  • Other (please specify)

Provide a detailed account of how the mining operation has affected you, your community, or the environment. Include specific details of any human rights abuses or environmental infractions.

5. Date of First Observation

(Approximate date or time range when the issue was first noticed.)

 

6. Estimated Number of People/Communities Affected

 

7. Actions Taken

Describe any actions you or your community have already taken to address the issue and the responses received.

8. Supporting Evidence

List and attach any supporting documents, photos, or other evidence.

9. Demand/Request Sought

What steps or remedies do you seek to address the issue?

Confidentiality and Further Steps

  • I wish to remain anonymous.
  • I waive my right to confidentiality and request to accompany any inspections.
  • I request the agency to maintain my confidentiality.

Signature/Thumbprint

 

Date

 

For Official Use Only

Received by (Name of Officer)
 
Date Received
 
Reference Number
 
Follow-Up Required
 
Action Taken
 
Closure Date
 
Signature & Name of Closing Officer