Incident reporting form

This form is primarily for recording and monitoring purposes.

Incidents/complaints of discrimination, harassment, bullying or victimisation

Type of incident (please select one or more categories which best describes what happened).
 
Was the incident related to *
Was the incident related to
 
Type of incident being reported? *
Type of incident being reported?
 
Was the incident: *
Was the incident:
 

Incident details

Date of the incident
Date of the incident
 
Time the incident occurred
Time the incident occurred
 
Is this the first time the incident occured?
Is this the first time the incident occured?
 
Has this incident also been reported to another agency/officer? *
Has this incident also been reported to another agency/officer?
 
 
 

Victim/complainant details

Organisation *
Organisation
Gender
Gender
 
Ethnic background
Ethnic background
 
White
White
Asian or Asian British
Asian or Asian British
Mixed
Mixed
Black or Black British
Black or Black British
Other Ethnic background
Other Ethnic background
 
The Equality Act 2010 considers a person to have a disability if:

You have a physical or mental impairment that has a substantial and long term adverse effect on your ability to carry out normal day-to-day activities.
Does the victim have a disability?
Does the victim have a disability?
 
Age group
Age group
 
Religion
Religion
 
Sexual orientation
Sexual orientation
 
Is the victim
Is the victim

Offender's details

Do you know the details of the offender?
Do you know the details of the offender?
 
Gender
Gender
 
Please indicate the offender's ethnic background
Please indicate the offender's ethnic background
 
White
White
Asian or Asian British
Asian or Asian British
Mixed
Mixed
Black or Black British
Black or Black British
Other Ethnic background
Other Ethnic background
 
The Equality Act 2010 considers a person to have a disability if:

You have a physical or mental impairment that has a substantial and long term adverse effect on your ability to carry out normal day-to-day activities.
Does the offender have a disability?
Does the offender have a disability?
 
Age group
Age group
 
Religion
Religion
 
Offender's sexual orientation
Offender's sexual orientation
Is the offender
Is the offender

Your details (if you are reporting incident/complaint on behalf of someone else)

Company
Company
 

Witness details (if any)

 
Please choose which department you want to send the form to: *
Please choose which department you want to send the form to:
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