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Home / Forms / Housing / Harrassment Reporting Form

Harrassment Reporting Form

Personal Details

Complainant's Name

 

Incident

Indicent Type(Tick all those appropriate)

Date of incident which has prompted complaint?

History

Have there been any previous incidents?

Alleged Perpetrators

How many perpetrators are there

Details of alleged perpetrator

First Perpetrator


Second Perpetrator


Third Perpetrator


Forth Perpetrator


Fifth Perpetrator


Sixth Perpetrator

Witness Details

First Witness


Second witness


Third witness


Forth witness


Fifth witness


Sixth witness

Police

Was the most recent incident reported to the police?

I understand that the information I provide on this form may be used in legal action. Therefore, I confirm that the information given is to my knowledge true.

What level has this case been graded at?

Ethnic Origin of complainant
Approvals and Consents

In order for the Council to take certain action we need your approval and consent.

1. CONSENT FOR INTERVIEW WITH ALLEGED PERPETRATOR

The Council has a policy of taking action to prevent anti-social behaviour. The first stage is to interview the person(s) you have made a complaint about.

I AGREE TO THE COUNCIL INTERVIEWING THE PERSON I HAVE COMPLAINED ABOUT

2. CONSENT FOR ACTION AGAINST ALLEGED PERPETRATOR

Following the interview with the person you have complained about, The Council may decide to take action against the perpetrator of nuisance and harassment and will need your assistance. The first step is to discuss the complaint with a Housing Officer.

I AGREE TO THE COUNCIL TAKING ALL APPRORIATE AND RELEVANT ACTION AGAINST THE PERSON I HAVE COMPLAINED ABOUT.

3. POLICE CONSENT

In order to progress your case it may be necessary to contact the police to obtain further information or confirm information already provided.

I AUTHORISE BOURNEMOUTH BOROUGH COUNCIL TO CONTACT THE POLICE TO OBTAIN INFORMATION THAT WILL BE OF ASSISTANCE IN DEALING WITH MY CASE.

4. MEDICAL CONSENT

It may be necessary for the council to gain information from your GP relating to one or more of the incidents you have reported. The information requested will only be used to support your case and for no other purpose. Please confirm that you are happy for this information to be obtained.

I AUTHORISE BOURNEMOUTH BOROUGH COUNCIL TO CONTACT MY GP TO SEEK ANY INFORMATION HELD ABOUT ME WHICH COULD BE RELEVANT TO THIS CASE.

Related Information

 

Postal Address Customer Services Centre,
St Stephens Road, Bournemouth, Dorset
BH2 6EB
Telephone 01202 451451
Minicom 01202 454974
Email Enquiries
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