The latest definition is: "A racist incident is any incident which is perceived to be racist by the victim or any other person"
If you think that you or someone you know has suffered racial harassment and needs help - You should consider reporting the incident to the Police, the Council, your School, your Union/Employer or any other agencies in your area as soon as possible.
You can use the form on this page as a general guide to help you gather all the relevant information regarding the incident/s which the Police or Council might need in order to take up your case.
Incident Report Form For Complaint Of Racial Harassment
Please give full and clear details of the incident and state what help or assistance you require or what your desired outcome and solutions are.
DETAILS OF PERSON(S) (VICTIM) SUBJECT TO RACIAL HARASSMENT
Surname
Forenames
Telephone
Address
Fax
Email
Date Of Birth
Age
Male
Female
Ethnic Origin Of Victim(s)
Language (if other than English)
Other (Specify)
Does The Victim Require An Interpreter?
Yes
No
COMPLAINT REPORTED BY
Surname
Forenames
Telephone
Address
Fax
Email
Relationship to Victim
Date Reported
Names(s) And Address(es) Of Witness(es)
NATURE OF COMPLAINT REPORTED (Tick as appropriate)
Racial Abuse (Verbal)
Attack On Personal Property Or On Home
Racial Abuse (Printed Material)
Threats Of Violence (Intimidation)
Other (Please Specify)
Racial Abusive Graffiti
Racial Attack (Physical)
FURTHER DETAILS OF COMPLAINT INCLUDING DATES, TIMES, LOCATION, THOSE INVOLVED ETC AS APPROPRIATE
HAS THE COMPLAINT BEEN REPORTED TO ANY OF THE FOLLOWING Agencies? (Tick as appropriate)
Housing Services Department
The Police
Education Authorities
Racial Equality Council
Probation Services
Local Ward Councillor
Health Services
Member Of Parliament
Social Services
Other (Please Specify)
Community Organisation (Please Specify)
CAN THE SUBJECT(S) OF THE RACIAL HARASSMENT IDENTIFY THOSE RESPONSIBLE?
Give Details, Names, Descriptions, Addresses:
Ethnic Origins Of Perpetrator(s) (if known)
If Any Other Agencies Involved Then Please Give Details
Name And Address Of Agency
Reference Number/s
Does the VICTIM CONSENT to the information being shared with other agencies?
YES
NO
(If You Tick NO - Then Please DO NOT Press The Submit Button)
I am providing this basic information on the basis and understanding that it will or could be used or shared by any other agencies or organisations such as the Police or the Council. This information is not sensitive or confidential in any way whatsoever. Furthermore I am happy to share and discuss this information with other agencies in order to resolve this matter. I confirm that I have not enclosed, disclosed or revealed any information to Communitylink Group which could be viewed or treated as sensitive or of a confidential nature.
