Tell Us Explain The Incident You can use this form to report to Stop Hate UK any Hate Crimes you have experienced or witnessed. You do not have to give your details. If you do give your details, you can choose who you want us to pass them to (e.g. local Police, local support agencies). If you need help immediately, call the Police on 999. If you want to talk to someone about the Hate Crime you have experienced, call the Stop Hate Line 24-hours a day on 0800 138 1625. If you don’t want to report a Hate Crime but would like to contact us, you can email us at info@stophateuk.org You do not have to answer all the questions. Please give as much detail as you can, so we can monitor Hate Crimes better. What do you think was the reason for the incident? Disability Gender identity Race Religion or belief Sexual OrientationAre you aPlease choose oneVictimWitnessThird-Party(required)What happened?Verbal abuse/name callingPhysical assault (inc throwing things at you, spitting, hitting)Damage to your home or vehicleArsonLeaving rubbish/Throwing things at your home/vehicleAnti-Social BehaviourThreats/Intimidation (verbal or written)Written abuse (letter/text/email/internet)GraffitiTheft/robberyBurglary (breaking into your home)Sexual abuse/rape/indecent actProblem with the policeProblem with an organisationDiscrimination at workOther (specify)When did it happen? Please be as precise as possible.(required)Where did it happen? Please be as precise as possible, and give details of the nearest town or city as well as the location(required)What happened? Please give as much detail as possible.Was it part of ongoing incidents?Please choose oneYesNoWas anyone hurt? If so, please give details.If items were stolen or damaged, what was the approximate cost of these?If any offenders were male, how many were there?If any offenders were female, how many were there?How old were they?Please choose oneUnder 1212-1818-2425-4040-6565+Not KnownWhat do you think their ethnicity was?Please choose oneBangladeshiIndianPakistaniOther AsianChineseGypsyTravellerBlack CaribbeanBlack African Other Black background White English White Welsh White Scottish White Irish Other White European Other White background Mixed Dual Heritage White & Asian Mixed Dual Heritage White & Black African Mixed Dual Heritage White & Black Caribbean Other mixed background Any other Prefer not to sayIf you chose other Ethnicity, can you state which?Can you describe them? e.g. hair colour and style, height, build, the clothes they were wearing, any recognisable features such as tattoos Do you know who they were? Please give their name and address if you can.How do you know them? (e.g. neighbour)Did they use a vehicle? If so, please give the make, model, colour, registrationDid anyone see it happen? If so, please give any details you haveHas the incident been reported to anyone else?PoliceWho Else?Do you have a Police Crime Reference Number for the incident? Please give it here.If the incident has not been reported anywhere else, was there a reason for this? About the VictimWe would like to know about the victim of the incident. If you are the victim of the incident, please give as much detail as you want. If you are a witness or a third-party, please give as much detail as you can.What is the victim’s ethnicity?Please choose oneBangladeshi Pakistani Indian Other Asian Chinese Traveller Gypsy Black Caribbean Black African Other Black background White English White Welsh White Scottish White Irish Other White European Other White background Mixed Dual Heritage White & Asian Mixed Dual Heritage White & Black African Mixed Dual Heritage White & Black Caribbean Other mixed background Any other Prefer not to say(required)If you chose other ethnicity, can you state which?What is the victims date of birth (approximately)?(required)What is the victim’s gender?Please choose oneMaleFemalePrefer not to say(required)Is the victim’s gender the same as they were given at birth?What is the victim’s sexual orientation?Please choose oneLesbianGayBisexualHeterosexualPrefer not to sayWhat is the victim’s religion/belief?Please choose oneBuddhist Christian Hindu Jewish Muslim Sikh Other religion, faith or belief None Prefer not to sayIf you chose other religion/belief, can you state which?Does the victim have a disability or health problem?Please choose oneblind or visual impairment deaf or hearing impairment speech impairment learning difficulty or disability mental health condition mobility long term health condition or disability other not known nonePrefer not to sayIf you chose other disability, can you state which?What type of housing does the victim live in?Please choose oneOwner OccupierLocal Authority or Housing AssociationPrivate RentedOthernot knownIf you are the victim of the incident and want more help, please give your details here.Please choose one of the following three privacy choices:I do not want to give any further details, and do not want any contact from the Police, Stop Hate UK or any other organisationsI want the victim’s details to be passed to the Police AND a local support agencyI want the victim’s details to be passed to a local support agency. I do NOT want the Police to have the victim’s details.What is the victim’s name?What is the victim’s address?What is the victim’s phone number?What is the victim’s email address?Would the victim prefer to speak in a language other than English?Are there any other requirements the victim has when they are contacted? (e.g. using Text Relay, not leaving messages)Are there any other organisations the victim does NOT want us to pass their details to?About YouIf you are not the victim, how do you know the victim?Please choose oneFriend/FamilyProfessionalI don't know the victim, I just witnessed the incidentIf you are not the victim, what is your name?If you are not the victim, what is your address?If you are not the victim, what is your phone number?If you are not the victim, what is your ethnicity?If you are not the victim, what is your gender?Please choose oneMaleFemaleIs your gender the same as you were given at birth? If you are not the victim, what is your date of birth?Is there any other information you want to give us?How did you hear about Stop Hate UK?Please choose oneAdvertisementCouncilHousing officeInternet search engineLeafletLocal Hate Crime reporting centreNewsletterNewspaperPolicePosterUsed Stop Hate UK beforeWord of mouth/recommendationWorkOtherNot known(required)
