Human Trafficking Victim Tracking Tool

Please complete this form should you or your employee encounter a case in which you suspect some form of human trafficking exists. The information provided will be used by the Illinois Department of Human Services and the Illinois Rescue & Restore Coalition to conduct quarterly and annual statistical reports on human trafficking for the State of Illinois.

General Information (Section 1)

If confirmed, how was victim identified?

Demographic Information (Section 2)

Race:
Status:

Details of Exploitation (Section 3)

Exploitation Type:
- a scheme, plan, or pattern intended to cause a person to believe that, if the person did not enter into or continue in such condition, that person or another person would suffer serious harm or physical restraint or the abuse or threatened abuse of the legal process.
- the recruitment, harboring, transportation, provision, or obtaining of a person for the purpose of any sex act in which anything of value is given to or received by any other person.
- the condition when a person who is under control of another person promises to pay money owed with his or her labor or through the personal services of a child under his or her control as a security for debt.
- a status of involuntary servitude based upon real or alleged indebtedness.
Method of Recruitment:
Recruited by: