Docstoc

Multi Agency Prejudice Reporting Form

Document Sample
Multi Agency Prejudice Reporting Form Powered By Docstoc
					Not to be completed by the public

Multi Agency Prejudice Reporting Form
This Front Page and Sections 4 and 5 MUST be completed in all cases
Any incident, which may or may not constitute a criminal offence, which is perceived by the victim or any other person, as being motivated by prejudice or hate Date of Recording
1 Yes 2 Is there a requirement for: Translator 3 Interpreter Any other special provision
If the incident has already been reported to another agency consider working together to solve any on-going problems

Time of Recording
No
This is a prompt to ensure that filling in the form doesn’t cloud dealing with the situation when immediate action is required

Did this / does this incident constitute an emergency or immediate action?

Has this incident already been reported to another agency? Yes No If yes, where has it been reported?

4

Was this a repeat incident? Yes Yes No No Was the previous incident reported? If yes, who was it reported to and when?

If this is a repeat incident establish what further action has already been taken, or where further action has failed when dealing with this incident

5

Was this incident part of an ongoing problem? Yes No If yes, how long has this been a problem?

If this is an ongoing problem there may be implications for further action to consider

6

This incident being reported relates to: Age Disability Race Gender Sexual Orientation Faith

The incident may relate to more than one area, tick as many as the victim(s) identifies

7

The recording agency for this incident: Statutory Agency Voluntary Agency Community Sector Private Sector

Tick the relevant box for your agency and enter agency name in space provided

8

The incident relates to: Community Complaint Against a Service Agency (internal) Go to Section 1 of this Report Go to Section 2 of this Report Go to Section 3 of this Report

SECTION 1 - If the incident involves 2 or more members of the public it would be a community-based incident. SECTION 2 - A complaint about an employee, policy, procedure or outcome against an agency by a member of the public, an external agency or an employee of the organisation made through a third party, would be an external agency incident. SECTION 3 - A complaint against an employee against another employee, or an employee making an internal complaint against a policy, procedure or outcome; or an employee complains against a member of the public would be an internal agency incident.

1

Not to be completed by the public

Section One - Community Based Incident
1 Exact Location of Incident: Postcode: Date: Time: Telephone Number (if applicable): 2 Nature of complaint reported: Abuse (Verbal) Abuse (Physical) Abuse (Graffiti) Other (please state) 3 Please detail what happened:
Describe the exact nature of abuse, including full details of gestures made and words used by the offenders There could be a number of options for this, so allow the person to explain rather than offer these few options, it may become clearer during discussion Please give accurate address at which the incident occurred, including postcode if possible

Threats of Violence (intimidation) Harassment (e.g. phone calls, letters) Damage to personal property or home

Please use extra sheet if required

Alleged Suspect Details
4 Can those responsible for the incident be identified? Yes 5 6 No
Please refer to the Information Sharing Protocol regarding the details of the alleged suspect

How many individuals were involved in causing the incident? Description if possible: Gender Ethnicity Hair Colour Name (if known): Address (if known): Age Height Build

2

7

Did the individuals have any distinctive features? Yes No If yes please provide details:

If any distinctive features, please add details in space

8

Were those involved wearing any distinctive clothing that could help identify them? Yes No If yes please provide details:

Please add details in the space provided

9

Relationship to the victim: Yes No

This could be a family member/work colleague, neighbour

10 Were there any witnesses? Yes No If yes please provide details: 11 What does the victim or witness want to happen next?

Get as much detail as possible, including any names and addresses

It is for the individual to state what they need or would like to happen, but it should be recognised that they may need to be provided with options. This could involve sitting down with reps from the organisation and an advocate to try and resolve the issue, (i.e. a multi agency conference), an apology, a warning to the perpetrator, relocation of the victim, removal or graffiti, referral to independent organisations, further investigation which could lead to a number of internal solutions to more robust intervention depending on the complaint i.e. legal advice and legal remedies. If the victim(s)/witness(es) wants no further action you will need to outline the options available, please refer to the Support Pack

12 Any further details:

Ask if the victim(s) or witness(es) saw if there were any CCTV cameras in the area

Please move to SECTION 4 and complete the information as appropriate
3

Not to be completed by the public

Section Two - Complaint against the service
1 Which agency/organisation/practice/group is being complained about?
(please write the name below)
This can be statutory, private, voluntary or community sector

2

Details of agency/person being complained about: Address: Postcode: Telephone: Details of person(s) complainant dealt with at the organisation:

3

What is the nature of the complaint? (detail complaint at Question 4) Refused a service Refused accommodation Refused employment Conduct by staff at service Other (please specify)

There could be a number of options for this, so allow the person to explain what happened rather than offer these few options, it may become clearer as the case is discussed

4

Please detail what happened:

Allow complainant to put this detail in their own words (do not add your own interpretation). Use separate sheets if necessary

Please use extra sheet if required 5 When did this happen? Date: Time: Started on since including: 6 and has continued on a number of occasions
This could have happened more than once and so it is vital to ask this and find out, it could help identify the problem and therefore the best solution i.e. it is a particular member of staff who is causing a problem This allows the complainant to state whether the problem has been occurring over a longer period of time rather than just a one off incident

Has this happened before with this organisation? Yes Yes No No With another organisation?

4

7

Did the complainant complain at the time/report this to anyone else in the organisation? Yes Further comment: No

The complainant may have tried to report this to someone else unsuccessfully so the further comment allows for this to be added

8

Has the complainant since reported this to the organisation using their complaints procedure? Yes No Not yet but I intend to (if YES - answer question 9, if NO - go to question 10)

9

If yes, was this helpful/was the issue resolved/a solution/explanation offered? Yes No (please explain your response)

The complainant may have copies of letters that they have written and responses that would be useful to build up a further picture and help establish next steps

10 If no, was the complainant aware of the organisations complaints procedure/or made aware at the time they had such a service? Yes No

The complainant could have tried to take the matter further but was unaware of the organisations own complaints procedure. The complainant should be offered details of the relevant agencies complaints procedure

11 Did anyone witness what happened? Yes No Not sure
This may be a family member or someone they know. If they don’t know, the organisation could follow this up either by the asking for details from the organisation being complained about (internal investigation) or a third party. You will need to contact the organisation for advice on this. Be aware that they can refuse to supply any details.

12 Does the complainant know the witness(es)? Yes If Yes, please detail below: No

13 Would the witness be willing to tell the agency receiving the complaint what happened? Yes No Not sure

By speaking to a third person this may help build up a further picture of what happened and help to identify possible solutions to the problem

14 How has this affected the complainant?

Let the complainant explain in their own words the effect this has had on them/their family

Please move to SECTION 4 and complete the information as appropriate
5

Not to be completed by the public

Section Three - Complaint where member of staff is victim
1 Is the complaint against Member of the Public A policy 2 Do you know this person? Yes If Yes, please detail below: No Work Colleague A procedure An Outcome
If the person is known, this will be followed through internal investigation in the organisation respecting the complainants confidentiality

This information will be kept confidential unless the victim explicitly states otherwise

3

Brief outline of the nature of the incident/complaint:

Allow individual to put this detail in their own words (do not add your own interpretation). Keep in mind that you may not be the best person to take details if there is a conflict of interests e.g. line manager or same sex issues. Give the individual options to go elsewhere. Please refer to the Support Pack for guidance

Please use extra sheet if required 4 When and where did the incident happen? Date: Time: Location Postcode: 5 Did anyone witness the incident? Yes No If yes, do you know the witness?
If the witness is known, write their name in the space provided

6

Would the witness be willing discuss what happened with an investigation Yes No Don’t Know

Speaking to a third person may help build a picture of what happened and identify possible solutions The individual may have tried to report their line manager but this may have been unsuccessful either because the line manager is involved in some way, or is not taking the issues seriously

7

Have you discussed this with your line manager or another suitable manager? Yes No

If yes, do you feel that the incident was handled sensitively and competently? Yes No

6

8

How has this affected you?

Let the individual explain in their own words the effect that the incident has had on them and their family

9

What does the victim/complainant want to happen?

This could involve sitting down with reps from the organisation and an advocate to try and resolve the issue, an apology, further investigation which could lead to a number of internal solutions to more robust intervention depending on the complaint. This could relate to other personnel, or policies etc.

10 Are you aware of internal HR/Personnel policies
eg. Bullying & Harassment Grievance & Disciplinary?

The complainant may have tried to take the matter further but was unaware of the organisations own procedure. Provide the person with the appropriate policy and help them think through their options under that policy This may be inappropriate if the line manager is the person being reported against

Yes

No

11 Would you be willing to let an investigation officer discuss what happened in terms of taking forward the actions with your line manager? Yes No

Please move to SECTION 4 and complete the information as appropriate
7

Not to be completed by the public

Section Four - Further Action to be taken
1 Do the victim(s)/witness(es) want the information passed to another agency? Yes If Yes, please detail below: Police Dorset Race Equality Council Victim Support Housing Department/Association Education Authority/School Probation Service Health Service Caseworker/Adviser Local Councillor or MP Other (please state)
*Be aware of the implications of the Human Rights Act 1998 and the Data Protection Act 1998. *In the case of court proceedings, either criminal or civil, the information given may be disclosable. Any court action will require the provision of statements and possible the need to attend court in person

No

This may enable further information to be used in the investigation of this incident, from other organisations. Or may be used for monitoring purposes. Some of the voluntary agencies provide case work or advocacy services to support individuals. It is important that complainants are encouraged to approach or pass on the information to these organisations so that they are supported more effectively. Please refer to the Support Pack for details regarding support available from each agency and their contact details.

2

Consent to share the information or take the complaint further:

“I consent to the contents of this form being shared with the agencies as detailed above (12)”
To be signed by the victim(s)/parent/guardian/witness(es): Date: To be signed by interpreter (where applicable) Date: 3 Further ACTION taken by the AGENCY receiving the report:

This allows the complaint to be further investigated/actioned with the consent of the victim. Young persons under the age of 17 years of age will need a parent or guardian to sign on their behalf.

Please enter further action to be taken by the agency and the date by which the action should be completed. Please refer to your relevant local protocols. This information will act as an audit trail and could be used in subsequent investigations. It is important therefore that the information is updated and accurate.

Date:

6 8

The Outcome
4 What were the outcomes of each action?
(Please provide dates and details and be aware that this could entail a long time gap)
There are many possible outcomes to a complaint of this kind, for example a possible answer could be, the organisation investigated, (this is not relevant if the complaint is about 2 members of the public), found the claim to be true and disciplined the member of staff and a written apology was sent to the complainant. Alternatively the claim could not be found in favour of the complainant.

5

Was the complainant happy with the outcome? (explain the response) Yes No

There will be many reasons why they may or may not be happy. If no prejudice or discrimination has been found it is likely the complainant will be unhappy, or if it has been found they may have been content with a written apology. Please refer to the Support Pack.

6

Will the complainant be appealing against the outcome/decision? Yes No If yes, please provide details:

Please detail how, when and why. Please refer to the Support Pack for further advice and guidance.

Please move to SECTION 5 and complete the information as appropriate
9

CONFIDENTIAL Not to be completed by the public

Section Five - Relevant for all incident reports
VICTIM / WITNESS * DETAILS (*delete as appropriate) This form can still be completed for victims who wish to remain anonymous. All fields are optional. Name Address Postcode Telephone Email Mobile Date of Birth

Completion of the below questions will not enable anyone to identify you
Gender Sexual Orientation Preferred Spoken Language

Ethnic Origin (2001 Census Categories)
Wherever possible the individual should self-classify White British White Irish Any other White background White and Black Caribbean White and Black African White and Asian Any other mixed background Chinese Any other ethnic group
E.g. Traveller of Irish Heritage, Gypsy/Roma. Please specify

Black or Black British Caribbean African Any other Black background Indian Pakistan Bangladeshi Any other Asian background

10

Religion (2001 Census Categories)
Wherever possible the individual should self-classify No Religion Christian (including all denominations) Jewish Atheist/Agnostic Any other religion
Please specify

Buddhist Hindu Muslim Sikh

Disability (categories according to the Disability Discrimination Act)
Do you have a long standing illness, disability or infirmity? (Long standing means anything that has troubled you over a period of time,
or that is likely to affect you over a period of time)

Yes

No

Does this illness or disability limit your activities in any way? Yes No

If yes, please indicate from the list below, where this illness or disability has an adverse affect on your ability to carry out normal activities: Mobility Manual Dexterity Physical Co-ordination Continence Ability to lift, carry or move everyday objects Speech, hearing or eyesight Memory or ability to concentrate, learn or understand Understanding of the risk of physical danger

The complainant should be given a copy of the relevant completed sections and in due course a copy of the outcome for their information
Report taken by ..........................................................................................Telephone ............................................................ Agency .......................................................................................................Department .......................................................... Signature ....................................................................................................

11

Dorset Race Equality Council will be scrutinising and monitoring racist incidents. The multi agency partners ask for any similar expressions of interest to provide such a monitoring/scrutinising role to contact: The Community Safety and Development Manager, Borough of Poole on 01202 633027 This form has been developed through Multi Agency Working Groups from Bournemouth, Poole and Dorset. If you have any comments or suggestions regarding the content of this form please email: community.safety@poole.gov.uk
K47/10/06

12


				
DOCUMENT INFO
Shared By:
Stats:
views:4
posted:1/16/2010
language:English
pages:13
Description: Multi Agency Prejudice Reporting Form