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	Bassetlaw District Council Queen's Buildings, Potter Street, Worksop, Notts, S80 2AH
	01909 533533
	01909 501758
	Customer Services
	How To Text Us
	01909 534999 (Emergencies)
	Opening Hours 08:45 - 17:00 (Mon - Fri)

Report an Incident

If you or someone you know is a victim of anti-social behaviour, domestic violence or hate crime you can now report the incident on our on-line form.

Details of this incident may be passed to other organisations to enable us to successfully investigate the incident and also to ensure a satisfactory and safe outcome for you.

A member of the Community Safety team will contact you shortly.

On-line incident reporting form


Contact Details
Full Name:*

Address:*

Telephone Number:

Email address:

Are you happy for us to contact you, using either the telephone or email provided for further information?

If none, can you suggest a safe means

In order for us to involve the right organisations in this investigation, please indicate which of the following applies. Are you?

Please state other provider:
Information about the incident Any detailed information given will assist officers investigating your complaint. Please ensure that you only record details of incidents which you have personally witnessed. By submitting the information, you are certifying that it is a true statement of what you have experienced.
Type of Incident

Date of incident:

Time of incident:

Where did the incident occur:

Persons involved:

Details of incident:

Have you reported the incident to Police?	Yes No

If yes, please give details here. The incident number and/or the name of the Police Officer and the date it was reported.
Extra Information The following questions are optional. But by doing so you will help us make sure that we give a fair service to all people in the community. This information is strictly confidential.
Are you happy with the choices you have for reporting incidents?	Yes No
Please provide us with details

Do you feel that there are any barriers when reporting incidents?	Yes No
Please give us details of any barriers you have encountered

How would you like to improve the choices that are available to you?

What sex are you?

Do you have a disability?	Yes No

What is your ethnic type?

Type the numbers you see in the picture below.

Please refer to our Privacy page for information concerning the data you send to us and how we use it.

Last Updated - 19/01/2012

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