Community Safety - Racial Abuse Reporting Form

Report Racial Incidents

Information which must be provided to process this form is shown by an [*].

All other information fields are optional.

Ethnic Group:

[*] Title:

[*] First Name: Paul, Claire, James.

[*] Last Name: Andrews, Scott, Sinclair.

[*] Date of Birth:

Occupation: joiner, clerk.

[*] Daytime Tel: Please include area code.

[*] Evening Tel: Please include area code.

Address details

[*] Address:
Please supply the Company name if using a business address.

[*] City / Town: e.g. Barrhead, Giffnock, Eaglesham

[*] Postcode: e.g. G71 2TW

Incident details

[*] Date of incident:

[*] Time of incident:

[*] Location:

[*] Details of Incident:
Please describe the incident briefly with as much detail as possible.

Special Requirements (if requested by the reporter / victim)

Preferred Language:

Interpreter Required:
Yes No

Female Office Required:
Yes No

Police Contact Phone ONLY:
Yes No

Plainclothes Preferred:
Yes No

Declaration

This section must be read by / to the victim / reporter before information and signature is requested.

The information contained in this form will be held for Policing and administration purposes and to assist in identifying repeat victims and offenders.

The information may also be shared with statutory agencies and others who work in partnership with Strathclyde Police to tackle race issues. It will not be shared without your consent unless required by law or where there is an overriding public interest to do so.

I ( Victim / Reporter )

I ( on behalf of )

I ( Victim )

East Renfrewshire Council

Racial Abuse Reporting Form