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VIEWS: 4 PAGES: 5

  • pg 1
									                                              REMOTE
                                         INCIDENT REPORT
Agency Ref No:                                                      Date Reported:
Police Ref No:
CR/Captor No:
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This Form is to be completed by staff noting details of any incident or information and
should be faxed or e-mailed to Lothian and Borders Police, Force Communications
Centre on 0131- 440- 6889 /6888 or remote.report@lbp.pnn.police.uk For the attention
of The Public Assistance Desk Supervisor

This form is NOT appropriate for incidents or information that require an
immediate response. If you do require an immediate response, dial 999 or
contact your local Police Station.
---------------------------------------------------------------------------------------------------------------------------
1. INCIDENT:

When did this happen?
Time:               Day:                                       Date:

Where did this happen? (i.e. in or near the home/street/place of worship/business
premises)



2. TYPE OF INCIDENT:

Which of these best describes what happened?
(More than one category can be ticked)

Assault                     Verbal Abuse/Threats                        Graffiti

Damage to Property                           Theft

Other (Please provide details)

What do you think the motive behind this was?



3. SUBJECTS WISHES:

Are you the victim of this incident or are you reporting it for another?

Victim/Reporting for another - (relationship)

What can we do to help you have this incident recorded?
  (i)    Report the matter to the Police and make arrangements for officers to meet
         with you to carry out a full investigation?

    (ii)      Report the matter to the police formally but ask them not to investigate it
              further? (Option for victim only)

    (iii)     Would you like to report this incident for information/intelligence purposes
              only?
as6 (03/05)
In any event, would you like the police to contact you about this?
Yes / No
If YES to above, would you like the police to make any specific arrangements, to do
this? (e.g. contact via member of staff, meet away from home address, meet in
presence of staff member, plain clothed police officer only etc.)




Would you require an interpreter or any other assistance? (e.g. disability access)




4. SUBJECT DETAILS:
Would you provide your personal details for the police? Yes / No
Full Name:

Age:                                    Date of Birth:

Gender:                                  Occupation:

Address: (including postcode)



Contact Number:

Have you been the victim of similar crimes before? Yes / No
If so, did you report it to the police? Yes / No
4. (i) If you are not the victim, can you provide the victims personal details?   Yes / No
Full Name:

Age:                                    Date of Birth:

Gender:                                  Occupation:

Address: (including postcode)



Contact Number:

In any event, would the victim like the police to contact them about this?        Yes / No
If YES to above, would you like the police to make any specific arrangements, to do
this? (e.g. contact via member of staff, meet away from home address, meet in
presence of staff member, plain clothed police officer only etc.)




Would the victim require an interpreter or any other assistance? (e.g. disability
access)

as6 (03/05)
5. SELF DEFINED ETHNICITY – VICTIM ONLY: (Optional)

Which of these groups would best describe your ethnicity?

Indian                  Pakistan           Bangladeshi

Asian-Other (Specify)

Caribbean               African

Black-Other (Specify)

Chinese

Mixed (Specify)

White-British           White-Scottish     White-Irish

White Other (Specify)

Gypsy                   Unknown
Traveller

Declined                Other

6. SUMMARY OF INCIDENT / INFORMATION:

Could you describe exactly what happened? (Include as much detail as possible and
continue on a separate sheet if necessary)




as6 (03/05)
7. DESCRIPTION OF PERSONS RESPONSIBILE:

Do you know who was responsible for this? YES / NO (Include as much detail as
possible and continue on a separate sheet if necessary.)
Name & Address (If known)


Can you describe the person(s) responsible?

Age                  Gender                       Ethnic appearance

Height                      Weight

Hair (colour, length and style)

Eyes (include if glasses worn)

Scars/Marks or Tattoo’s

Can you describe what the person(s) responsible were wearing?
Clothes

Can you think of any other relevant information?




8. WITNESSES:
Were there any witnesses to this incident? Yes / No(Include as much detail as possible
and continue on a separate sheet if necessary)
(1) Name:                                                                                      Age:
Address:

Contact Number:

(2) Name:                                                                                      Age:
Address:

Contact Number:
---------------------------------------------------------------------------------------------------------------------------
OFFICE USE ONLY
9. INITIAL ACTION TAKEN BY REPORTING AGENCY: (Include all agency referrals. If the
informant is a repeat victim, specify what action, if any, has been taken in relation to previous
incidents)




Agency/Partner Submitting Report:

Member of Staff Involved: (Please print name)

Contact Number:

as6 (03/05)
                                            POLICE USE ONLY
10. DIVISIONAL CRIME MANAGERS/CRIME DESK INSTRUCTIONS:




Allocated to:


Please ensure that the Local Community Safety Department is updated with
details of enquiry officer

---------------------------------------------------------------------------------------------------------------------------
11. SUMMARY OF INVESTIGATION:




---------------------------------------------------------------------------------------------------------------------------
12. REFERENCE NUMBERS:

Captor Incident Number:                                        CR Number(s):

Has Finalisation Sheet (Force Form                         ) been forwarded to Reporting Agency?
Yes / No
Date?
If No, then reasons why?


---------------------------------------------------------------------------------------------------------------------------
13. FINAL OUTCOME: (e.g. arrest, summons, unsuccessful inquiry, logged for
intelligence purposes, etc. (please provide brief details)




ENSURE COPIES OF COMPLETED REMOTE REPORT FORMS ARE E-MAILED
OR FORWARDED TO THE LOCAL COMMUNITY SAFETY DEPARTMENT AND
FORCE DIVERSITY UNIT.


Reporting Officer:                                                         Date Sent:


as6 (03/05)

								
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