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Request an antisocial behaviour review
Request an antisocial behaviour review
Last Modified August 14, 2018
Download as PDF
pdf
Are you activating the trigger on behalf of someone else?
Yes
No
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Do you have their permission to do so?
Yes
No
If not, why not?
Your name
First
Last
Your address
Your postcode
Your telephone number
Your relationship to the victim
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Please select if:
You, as an individual, have complained about three separate incidents within the last six months
Five people in the local community have complained about the same or similar incidents within the last six months
You, as an individual, have complained about an incident motivated by hate (hate incident/hate crime) within the last six months
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Complainant details
Name
First
Last
Address
Address line 2
Town
Postcode
Daytime telephone number
Email address
Incidents
Please provide information for each of the three incidents of antisocial behaviour you have experienced. Please provide as much detail as possible.
First incident
Date the incident happened
Who did you report it to?
Details of the incident
What response did you receive from the agency you reported to about the incident?
Second incident
Date the incident happened
Who did you report it to?
Details of the incident
What response did you receive from the agency you reported to about the incident?
Third incident
Date the incident happened
Who did you report it to?
Details of the incident
What response did you receive from the agency you reported to about the incident?
Have you supplied all the relevant information
Yes
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Local community complaint
Please give the following information for each of the five complaints.
First complaint and main contact
Name
First
Last
Address
Address line 2
Town
Postcode
Daytime telephone number
Email
Date incident happened:
Who did you report it to?
Details of the incident
What response did you receive from the agency you reported to about the incident?
Second complaint
Name
First
Last
Address
Address line 2
Town
Postcode
Daytime telephone number
Email
Date incident happened:
Who did you report it to?
Details of the incident
What response did you receive from the agency you reported to about the incident?
Third complaint
Name
First
Last
Address
Address line 2
Town
Postcode
Daytime telephone number
Email
Date incident happened:
Who did you report the incident to?
Details of the incident
What response did you receive from the agency you reported to about the incident?
Fourth complaint
Name
First
Last
Address
Address line 2
Town
Postcode
Daytime telephone number
Email
Date incident happened:
Who did you report the incident to?
Details of the incident
What response did you receive from the agency you reported to about the incident?
Fifth complaint
Name
First
Last
Address
Address line 2
Town
Postcode
Daytime telephone number
Email
Date incident happened:
Who did you report the incident to?
Details of the incident
What response did you receive from the agency you reported to about the incident?
Have you supplied all the relevant information
Yes
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Next Page
Complainant details
Name
First
Last
Address
Address line 2
Town
Postcode
Daytime telephone number
Email
Date incident happened:
Who did you report it to?
Details of the incident
What response did you receive from the agency you reported to about the incident?
Previous Page
Next Page
Email receipt
If you would like to receive an email receipt, please enter your email address.
Email
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Equality monitoring
As part of the Community Trigger, Blackpool Council is keen to ensure that all of the community are fully represented and have equal access to the process. In order to do this, we are asking those who use the Community Trigger fill out an equality monitoring form. This will give Blackpool Council a better understanding of who is accessing the process.
The data you provide here will be completely anonymised in line with Blackpool Council’s equal opportunities policy and, once submitted, will be kept completely separate from the personal details provided within your Community Trigger application. Your data will be used solely for statistical purposes.
Please note that this form is optional and you can skip this step, however your input would be greatly appreciated.
Are you
Male
Female
Prefer not to say
Do you have a disability? (A physical or mental impairment that has a substantial and long-term effect on your ability to carry out normal day-to-day activities):
Yes
No
Please tell us about it
Are you?
Bisexual
Heterosexual
Gay/Lesbian
Prefer not to say
Are you?
Christian
Jewish
Sikh
Buddhist
Hindu
Muslim
No religion
Prefer not to say
Other
If other, please specify
Ethnicity
White
White British
White Irish
Any other white background
Black or Black British
African
Caribbean
Any other black background
Asian or Asian British
Indian
Pakistani
Bangladeshi
Any other Asian background
Mixed
White and Black Caribbean
White and Black African
White and Asian
Any other mixed background
Chinese, Traveller or other ethnic group
Chinese
Gypsy or Traveller
Any other ethnic group
Are you an asylum seeker or refugee?
Yes
No
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Additional information
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