Reporting offensive incidents

1. Was the incident based on any of the following grounds?

2. Give a brief description of the incident, including what was said, gestures etc and why it was considered offensive. Please include the date and location.

For the Council to take action, it will help us to know as much as we can about the people involved in the incident. Any information you give us will be treated confidentially.

3. Your Details (please tick the option that applies to you)

Physical Disability

4. Please indicate your ethnic origin. (please select the appropriate option)

White

Black, or black British

Asian or Asian British

Mixed

Chinese or other ethnic group

5. Tell us about the person who you consider directly experienced the offence.

Physical Disability

6. Tell us about the person you consider was being offensive

Physical Disability

7. Please give us any other information that is relevant to this incident.

8. What action, if any, do you think the Council could take to avoid an incident like this happening again?

Please enter the security code shown above (this code is to prevent misuse of the form and verifies to us that you are a genuine sender, you do not need to keep a record of the code).