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Personal Incident Record Sheet - Victims of Racial Harassment

Personal Incident Record Sheet


(Please print out, complete and retain this Personal Incident Record Sheet for future reference)

Date Time Place of Incident Nature of Incident Details of Perpetrators Police & Other Agencies Involved Effect on Person
13/02/99 8.10 Approx. Back garden Threw stones into garden Three white boys, about 10-15 years old (If name known then please state) Police informed at 8.15 p.m. Scared and upset
13/02/99 9.30 p.m. Police arrived Police officer came and took statements, regarding the above incident. (State name and number of Police Officers and any action taken by them).
             
             
             
             
             
             

Page last updated: 9 May 2008