Report ASB form

This form is for you to record your experience of anti-social behaviour on.

It will be sent to a member of our Housing Team to investigate. They will contact you within ten working days of the case being reported to agree an action plan, and within 24 hours for high risk incidents. If you think your incident is high risk, please call our Customer Enabling Hub on 0300 100 1010.

1. Only write what you have seen, heard or experienced.

2. Please be aware that the information given may be used in subsequent legal proceedings.

3. The information given may be passed to other statutory agencies such as police, local authorities and other housing associations, so by completing this you are agreeing that we can do so.

4. Please complete one form for each incident which helps us to gather evidence and understand the whole story.

5. If you know someone else has already completed a form, we still wish to hear your feedback and experience, so please complete the form anyway.

Reporting Anti-Social Behaviour

Note: Questions marked by * are mandatory

*This is a mandatory field. Your name

Case number (if known)

*This is a mandatory field. Your address

*This is a mandatory field. Postcode

Phone number

Mobile number

*This is a mandatory field. Email address

*This is a mandatory field. What type of ASB does your report relate to? (You can find descriptions in our ASB toolkit)

Assault

Drug use and dealing

Group dissorder

Gun or knife crime

Noise

Pets

Sexual offences

Threat (of abuse or violence)

Verbal abuse, intimidation or harassment

*This is a mandatory field. Do you consider it to be hate crime (you can read more about this on our website)?

Yes

No

If you think it is a hate crime, what type of hate crime do you consider it to be?

Why do you perceive this to be motivated by hatred?

*This is a mandatory field. Please describe the problem or incident you are experiencing in your own words. Please give as much detail as you can:

*This is a mandatory field. Where did the incident or behaviour take place?

*This is a mandatory field. Date of the most recent incident

Time of the most recent incident (please be clear about am or pm)

*This is a mandatory field. Who was involved?

*This is a mandatory field. Were you or anyone else injured?

*This is a mandatory field. How did it make you feel?

How many offenders were there?

Do you know them?

*This is a mandatory field. Were there any witnesses and if so, do you know who they were?

*This is a mandatory field. Was the incident recorded on CCTV?

*This is a mandatory field. Did any loss or damage to property result from this incident?

*This is a mandatory field. How often has the problem occurred?

Have you completed ASB diary sheets?

Yes

No

Have you reported this to Westward before and if so could you please tell us when?

*This is a mandatory field. Did you inform the police (if so please tell us the log number here)?

If not, are you willing to give your details to the Police?

Yes

No

If you have reported this to any other agencies, when did you report it and who to?

*This is a mandatory field. What would you like to happen or what outcome would you like to see?

How would you like us to get in touch?

Email

Landline

Mobile

Text Message

*This is a mandatory field. Please tell us your ethnic group, for reporting purposes only

Please Select An Option White: English/Scottish/Welsh/Northern Irish/BritishWhite IrishWhite: Gypsy/Irish TravellerWhite OtherMixed: White and Black CaribbeanMixed: White and Black AfricanMixed: White AsianMixed: OtherAsian or Asian British: IndianAsian or Asian British: PakistaniAsian or Asian British: BangladeshiAsian or Asian British: ChineseAsian or Asian British: OtherBlack CaribbeanBlack AfricanBlack OtherOther ethnic group: ArabOther ethnic group: OtherTenant prefers not to say

*This is a mandatory field. Please tell us you age group

Please Select An Option 16-2021-3031-4041-5051-6061-6465 & overRather not say

*This is a mandatory field. Please tell us your gender

Please Select An Option MaleFemaleNon-binaryRather not say Transgender

This field protects against spam. Please answer the question below.

* Spam Guard: What is the day after Thursday?