Hate Crime / Incident Reporting Form

Please note: boxes with an asterisk (*) must be completed.

You have chosen to report an incident to the police.

The police and our partners take crime particularly seriously when they are motivated by hatred. Your report will be forwarded immediately to the relevant police force for investigation but it may not receive attention for several hours.

For this reason you should never use this form to report an incident where:

The offender is still present
You or anyone else is seriously hurt or in danger
You think the offender may return

In the above circumstances we would urge you to call 999 and the police will respond immediately.

Please tick this box to confirm you have read the above

Yes

Police area / county

In which police area / county did the incident occur?

Motivation

What type of incident are you reporting?

If 'Other' is selected please note, this form is only to be used for offences motivated by hatred. For other offences please contact your local police. If it is a hate crime, please specify the motivation.

Victim or witness

Are you a...?

Victim

Witness

Other

If you selected 'Other' please specify

The incident

Describe the incident in your own words. Please give as much detail as possible.

Why do you perceive this to be motivated by hatred?

What date did the incident take place? Please be as specific as possible

Choose a date

What time did the incident take place? Please be as specific as possible

Where did the incident take place?

Transport

If the incident took place on public transport was it...

Bus

Taxi

Train

Tram

Underground

Other

If other - please specify

Number of service? (if known)

Where were you travelling from?

Where were you going to?

Were you near a landmark?

Injury / damage

Were you or anyone else injured?

Yes

No

Not sure

If yes or not sure, please specify

Did any loss or damage to property result from this incident?

Yes

No

Not sure

If yes or not sure, please specify

Witness information

Were there any witnesses?

Yes

No

Not sure

Please give details

CCTV

Was the incident recorded on CCTV?

Yes

No

Not sure

Please give details if appropriate

About the offender(s)

Confidential - This information will only be used by the Police

How many offenders were there?

1

2

3

4

5 or more

Not sure

Do you know them?

Yes

No

Can you name them?

Yes

No

If you know them, please give details including address etc?

Can you describe the offenders? Please give as much detail as possible

Ethnicity of the offender(s)?

Vehicle Details

Did the offender have a vehicle?

Yes

No

Not sure

Vehicle make

Vehicle colour

Vehicle model

Vehicle registration

Any other details you can give about the vehicle - including direction of travel.

Your Details

Confidential - For Police use only - Private details are protected by the Data Protection Act

The police take hate crime very seriously and will record and investigate this offence even if you do not want to give your details. However, you must know that the investigation and ability to prosecute the offender(s) is severely limited if the police cannot contact you.

You may also specify how you are contacted and if contacting you would cause you any difficulties.

We will not pass on your details without your consent and would ask you to consider giving your details confidentially.

Are you willing to give your details to the Police?

Yes

No

What is your gender?

Female

Male

Other

If you selected 'Other' please specify

Your ethnicity

If any other ethnic group, please state:

Name

Address

City / town

Postcode

Daytime phone number

Evening phone number

Mobile phone number

Email address

Date of birth

Choose a date

Please specify how we may contact you

Any of the above

Some of the above

Through a third person

Please give details if only some, or through a third person, or if there are any barriers to communication.

The Police work with a number of agencies who may be able to help you or provide you with additional support. Would you be happy for the police to pass on your contact information to these agencies?

Yes

No

Your report is important to us. It will be forwarded to the local Police and will be recorded. As long as you did not report anonymously, an officer will contact you through your preferred channel of communication.

If you have not had contact back from your force within 7 days, please call them. You can find details of your local Police on the True Vision Police contacts page.