Your name *
Your address *
Telephone number *
Email address *
Preferred method of contact *
Phone Email
If by phone, best time to call
Is an interpreter needed, and if so which language?
Date incident(s) occurred
Where is the nuisance coming from? * - Next door neighbour People from the same street People from a different estate/area
Is more than one person causing the nuisance?
Yes No
Is the perpetrator under 18?
Yes No
What is the name of the perpetrator?
What is the address of the perpetrator?
Type of ASB * - Verbal abuse / harassment / intimidation Hate-related incidents Vandalism and damage to property Pet and animal nuisance Vehicle nuisance Drugs / drug-dealing / substance-abuse Alcohol-related Domestic abuse or physical violence Litter / rubbish / fly-tipping Garden nuisance Misuse of common areas / loitering Prostitution / sex acts / kerb-crawling Noise Racial harassment Other criminal behaviour
Details of ASB *
Have you taken any action to resolve the issue, i.e. spoken to the perpetrator(s)
Yes No
If yes, please describe the action taken
Have the police been informed? *
Yes No
If yes, please provide details, including crime reference no.s
Is this an original report, or does it relate to an ongoing case? *
Original report Ongoing case
If ongoing case, please type the ASB reference number (if known)
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