Community Trigger Referral Form

To view the latest Complaints, Compliments and Comments procedure please refer to this document.

The Community Trigger is a process you can use to ask agencies to review their response to anti-social behaviour or hate incidents you have reported. This is the Community Trigger referral form. Please complete this form as fully as possible. If you would prefer a printable copy of this form, it may be downloaded from our website. If you require further details about the Community Trigger initiative, please visit our website.

In an emergency please contact the relevant emergency service, police, fire or ambulance on 999.

1 Start 2 Complete

Type of referral

I am *

An individual complaining about 3 incidents of anti-social behaviour in the past 6 months or 1 hate crime incident in the past 3 months

One of a group of five people or more complaining about the same incident

Type of incident *

Hate crime

Anti-social behaviour

About you

Please tell us your name *

Please tell us your address (Excluding postcode) *

Please tell us your postcode *

A contact telephone number *

Your email address *

Which of these best describes you? *

Private tenant

Owner occupier

Housing association

Other

Please provide the name of your Landlord and contact details *

Incident details

Incident one

Date *

Day

Month

Year

What happened? *

Where did it take place? *

How has it affected you? *

Who did you report it to? *

Were you given a reference number? *

Yes

Please tell us the reference number *

What response did you receive to this first report? *

Incident two

Date *

Day

Month

Year

What happened? *

Where did it take place? *

How has it affected you? *

Who did you report it to? *

Were you given a reference number? *

Yes

Please tell us the reference number *

What response did you receive to this second report? *

Incident three

Date *

Day

Month

Year

What happened? *

Where did it take place? *

How has it affected you? *

Who did you report it to? *

Were you given a reference number? *

Yes

Please tell us the reference number *

What response did you receive to this third report? *

Additional information

Please use this space provided to let us know of any additional information you feel is relevant.

Declaration

Confirmation *

I confirm that the information given in the above form is correct to the best of my knowledge.

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Copeland E-Forms

Community Trigger Referral Form