Racial Harassment Report Form
Racial Harassment Report Form
All sections must be completed
Date
Time
Location/ Address
Type of Tenancy
(if Known)
Council
Leasehold
Owner/Occupier
Housing Assoc.
Private Rented
Person and Agency to which first reported
Date reported
Date faxed
Ward
(if known)
Victim(s) Details
Victim(s) Name
Tel. No.
Address
Age
Gender
Ethnic Group/ Country of Origin
School Name
School Address
Faith
(if relevant)
Suspect(s) Details
Name (if known)
Suspect(s) Age
Ethnic Origin
Gender
Nature of Incident
Verbal Abuse
Physical Abuse
Criminal Damage
Threatening Behaviour
Other
Is this the first reported incident?
Yes
No
Details of Incident
Does victim wish this incident to be reported to the Police?
Yes
No
For more information on this form please contact 020 8379 4182/ 4184
Enfield Council, Community Safety Unit, 1st Floor, Civic Centre, Enfield EN1 3XA