SPEAK OUT!
STOP HATE.

Have you witnessed or been a victim of a race or religious hate incident? By reporting it, you’re helping us to make a change.

When you submit this form, it will not automatically collect your details like name and email address unless you provide these yourself.

Date of incident (dd/mm/yy)

Time of the incident

Location of incident

Start typing or choose on map.

Incident description. Please provide as much information as you can including further location information.

Are you the victim of the incident?

If you are not the victim, are you acting on their behalf as a close friend/family member?

If you are not related or known to the victim, please still continue with this form. Any information you can give will be used to further support people.

Did this incident occur in a school? If so, please provide details of the school

Have you reported this incident to the Police or another agency?

If reported, crime reference number(s)

If not reported, are you happy for details to be passed to Merseyside Police?

Do you want someone to contact you offering more support, sign-posting and guidance?

If you would like support, please leave your contact details below.

Name

Phone number

Email address

Address

Date of birth

Additional information/details

If you are completing the form on behalf of someone else and have given their details for support above, are you happy for us to contact you with any follow up questions? If so, please provide your contact details (Name, phone number, email address, address) below:

SPEAK OUT!STOP HATE.

SPEAK OUT!
STOP HATE.