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Hate crime and incident self reporting form

This form has been designed for you to report any form of Hate Crime or incident that you may have directly experienced, witnessed or are reporting on behalf of someone else.

There is no need to answer the questions in section one if you prefer not to say but if you do this information will be in the strictest confidence.

You can also download a printable form here:

Click here for the hate crime self reporting form. (This form is in Adobe PDF format and takes you to the Lancashire Constabulary website)

SECTION ONE: YOUR DETAILS

Are you the victim or the witness of the incident?

Victim
Witness

What is your date of birth? (dd/mm/yyyy)

What is your gender?

Female
Male
Rather not specify

How would you describe your sexual orientation?

How would you describe your religion or beliefs?

How would you describe your Ethnicity?

Are you from the Gypsy or Traveller community?

Yes
No

SECTION TWO: DETAILS OF THE INCIDENT

What did you think motivated the crime?

When did the incident take place? Please state location, time and date. If there was more than one incident, please give details.

Were there any injuries or damaged caused? Please give details.

Tell us about the incident in your own words, giving as much detail as possible.

Please describe the offenders including details of clothing or distinguishing characteristics.

SECTION THREE: HOW WE CAN CONTACT YOU

Your name

Your address

Line 1
Line 2
Town
County
Postcode
Country

Telephone

Please tell us how you would prefer to be contacted. (i.e. only certain time or location/by email or phone)

My Tenant Zone

Hate crime and incident self reporting form

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