Section 5. Sample Forms

Initial Report of Incident (Form: RH1)

(To be filled in by whoever receives the complaint)

Name of victim

Gender

Age

Ethnicity

Address

Phone

Is the victim:   Victim

Witness

Other

Is the victim a tenant:   Yes

If no, please provide details

Details of incident (time, date, place etc)

Details of alleged perpetrator(s) (age, gender, ethnicity)

Witnesses (names and addresses)

Any previous incidents

Any previous incidents reported

Other agencies involved

Police informed

Interpreter helpful

Preferred location for interview

Name of officer taking report

Signature of officer

Date

Action

1. A copy of this form should be placed on a register of racial harassment reports kept in each housing management office.
2. A copy should be put in the victim's/tenant's file.
3. A copy should be forwarded to the investigating officer.
4. A visit to investigate the complaint further must be arranged within 24 hours of the complaint having been received.

Report of Visit to Victim (Form: RH2)

To be filled in by the investigating officer at the first interview at home following an incident. It may also be used to record other incidents if they occur subsequently.

Name of tenant or person affected

Address

Gender

Age

Ethnicity

Household Details

Number of adults and children - with ages of children

Date when incident occurred

Type of Incident: please tick appropriate box(es)

  Racist Graffiti in common areas

  Racist Graffiti on property where household lives

  Written abuse/threats

  Abusive telephone calls

  Verbal Abuse

  Damage to property

  Excessive noise

  Physical Assault

  Other (Please state) _______________________________________________

Details of Incident and the effect on household

e.g. health, education etc

Who else was present at the incident?

Give names and addresses, include any children

Details of Alleged perpetrator(s)

Where known, give names and addresses if the victim wishes to give this information

Have the police been informed?

If yes, give details including: police station and officer handling incident, and date reported

Does the tenant want the police to be informed? Yes/No

Support for the tenant

a) Does the tenant need any additional help? Yes/No

b) If yes, what help does the tenant need?

c) What action would the tenant like to be taken?

Details of other agencies involved: contact person/address

Advice Centre

Law Centre

Social Work

Schools

Councillor/MSP/MP

Community or voluntary organization

a) Is a transfer requested?

b) Is temporary re-housing requested?

Any other relevant information

Name of investigating officer

Signature of investigating officer

Date of interview

Action

1. This report will form the basis of subsequent interviews with the alleged
2. perpetrator(s) and with witnesses. It is therefore important that as much detail as possible is recorded.
3. A copy of this report should be kept on the victim/tenant's file.
4. The victim should be told to report any further incidents promptly to the housing provider. Where further incidents occur, this detailed report can be used to record the details.
5. A Schedule of Repairs (Form RH4) should be prepared by the investigating officer.
6. The victim should be given a diary sheet (RH3) to record any further incidents which occur. This is particularly useful if the organisation decides to take action to obtain an interdict or seek eviction of tenants who perpetrate racial harassment.

Personal Record of Incidents (Form: RH3)

It is essential that you keep an accurate record of any further incidents of racial harassment. This is necessary as a basis for any possible legal action.
N.B. This form can be translated into other languages for those who speak a language other than English.

DATE

TIME

WHAT HAPPENED?

POLICE

CONTACTED

(Give details)

ANY

WITNESSES

(Give details)

Record of Repairs Ordered (Form: RH4)

Address of Property:

Date repair requested

Nature of repair

Date completed

Cost of repair

Recharged to perpetrator?

Witness Report Form (Form: RH5)

Name of Witness

Address

Date of incident witnessed

Details of incident
(Ensure that the report made here by the witness details the incident as they saw it. Include as much information as possible).

Would the witness be willing to go to court?

Does the witness require an interpreter?   Yes / No

Investigating Officer

Signature of investigating officer

Date of Interview

Action

If the witness is a tenant, a copy should be put on their file

A copy should be kept on the victim's file

Alleged Perpetrator Interview Form (Form: RH6)

Name

Address

Gender

Age

Ethnicity

Details of Incident Reported

(This can be prepared beforehand for reference during the interview)

The Organisation's Policy

(This should be explained at this point)

The response

(Record the response to the particular action(s) which the person is alleged to have taken - try and record the conversation verbatim)

Interviewing Officer

Signature of Investigating Officer

Date of Interview

Action

1. A copy of this report should be put in the tenant's file (If the alleged perpetrator is a tenant)

Follow-up Report form - RH7

This form can be used to check on progress of action decided for the victim or perpetrator.

Victim/Perpetrator

Address

Gender

Age

Ethnicity

Agreed action

By whom

By when

Progress

Reporting Officer

Signature of reporting officer

Date

Action

1 Action agreed should be followed through and this report ensures that each element of the programme of action can be checked and monitored

2 A copy of this form should be on the tenant's or perpetrator's file.

3 If action has not been completed by the housing organisation it will become evident at this stage and remedial action can be taken.