Site Search & FAQs

Rother District Council

A-Z of Council Services:

You are here:
Home >
Community and Environment >
Community Safety >
Anti-Social Behaviour Reporting Form

Anti-Social Behaviour Reporting Form

Anti-Social Behaviour Reporting Form

If you have a problem with Anti-Social Behaviour you may complete this form, which will be forwarded to the Anti-Social Behaviour Co-ordinator.

Any information given will be treated in the strictest confidence.

Required fields *

Date: *

Time: *

Location of incident: *
e.g. town, street
Full details of incident: *
include names if known or description of all persons involved, e.g. clothing, direct speech (heard or said); vehicles used (including registration numbers); bicycles used (colours and description) etc.
Full details of behaviour (include gestures made, body language displayed etc): *

Did this behaviour cause you to feel harassed, alarmed or distressed? *
Yes No
If yes, can you say how much you were disturbed:
i.e. were you prevented from enjoying a specific activity such as: sleeping; watching television; enjoying the garden? How was the neighbourhood disturbed?
Did you take any action to stop the behaviour? *
Include as much detail as possible, e.g. actions, conversations
Are there other witnesses who can corroborate the incident? *
Yes No
If yes, please state who (and give details of their address/phone number if known):

Your Name: *

Your Maiden Name (if applicable, for police security purposes):

Your Address: *

Telephone Number:

Email Address :

Date of birth: (for police security purposes)*

Place of birth: (for police security purposes)*

Sex: *
Male Female
Would you be willing to appear in Court as a witness? *
Yes No
If not, would you speak to a third party to give evidence on your behalf?
Yes No
If you are willing to appear as a witness, are there any dates that you can't appear?
Yes No
If yes, please list below:

Do you give your consent for this statement to be used in civil proceedings? *
Yes No
Contact details (if different from above):
Address:

Telephone Number:

Data Protection Notice
Sussex Police is the data controller. The information you provide will enable the council to carry out its statutory duties. The information may be disclosed to other Police forces and regulatory authorities.

Print This Page

Related Downloads
Anti-Social Behaviour Reporting Form [PDF] [64kb]