Hate Crime reporting

Are you:

About you:
Your age:
Your gender:

Did the incident(s) happen because of?
Tick all that apply (real or perceived)

Please help us to monitor prejudice by telling us eg: actual race/ethnicity, disability type, religion or belief, age, LGBT status, gender here:

Location - Where did it happen?
Tick all that apply

Please help us to map incidents by telling us the actual location here:

About Perpetrator(s)
Approximate age:
Gender if known:
tick all that apply

Details of the incident
Verbal abuse:
Physical abuse:
Other:
tick all that apply

Please give Details of incident(s) eg: One off, repeat, by one or more people, when, what happened, race or ethnicity of perpetrator.

Have you reported the incident(s) to the police?
Yes I did report – please insert details of when you reported, what action is being taken?

If you did report could you describe the experience and if you would report in the future?

No I did not report – if no, please explain why you did not report to the police?

If you did not report what did you do instead of reporting and how did that made you feel?

What should be done to tackle the problems reported above?

DATA PROTECTION

All the information you give us is confidential. We may use it anonymously to help in our research and to improve services for victims. We would not use the information you give us if doing so identifies you in any way.

Personal Information – you DO NOT need to fill this part if you want to remain anonymous.

Filling in this part of the form will allow BD Citizens Advice Bureau to contact you confidentially.

Please use the tick boxes below to tell us what contact you want:





Title:

First name:

Surname:

Address:

Postcode:

Telephone:

Email:

Thank you for your time. This information is confidential. If you have any queries at all please call BD Citizens Advice Bureau Hate Crime Project on 020 8507 5968 or email us at hatecrime@bdcab.org.uk.