Fillable COMMUNITY TRIGGER REFERRAL FORM (London Borough of Harrow)

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COMMUNITY TRIGGER REFERRAL FORM (London Borough of Harrow)

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COMMUNITY TRIGGER REFERRAL FORM
The community Trigger is a process you can use to ask agencies to review their response to anti-social behaviour or
hate incidents you have reported. To use this process, you must meet the Trigger threshold, which is set at:
“If you (as an individual) have complained to the Council, Police or a Registered Housing Provider (social
landlord) about three separate incidents in the last six months and you consider there has been no action
taken”
If you meet the threshold, please complete the form as fully as possible. If the incident / matter does not meet the
threshold, then the matter can still be reported as an incident of ASB, and this will be actioned as a normal complaint
and followed up. To submit the form, or an incident of ASB, please email asb@harrow.gov.uk
If the matter is an emergency, please contact the relevant emergency service, police, fire or ambulance, on 999.
Contact Details
Please provide your details so that we can contact you. If you are completing the form on behalf of a friend or a client
of your service, please provide details of the person affected by the situation. We will use this to ask any further
questions or provide feedback on your referral as necessary.
Name:
Address,
including Post
Code:
Telephone:
Email:
Which of these best describe you?
Council Tenant (include leasehold) Private Tenant Owner Occupier Housing
Association
Other Please Specify: ________________________________________________________________
If you are a tenant, please provide us with your landlord’s name or the name of the contact officer, and any contact
details you hold for them:
Incident Details
Please provide details of the three separate incidents that have occurred in the last 6 months and been reported
Incident One
2
Date of Incident:
What happened?
Where did it take
place?
How has it affected
you?
Who did you report
it to?
If given a reference
number, please
state it
What response did
you get to this first
response?
Incident Two
Date of Incident:
What happened?
Where did it take
place?
How has it affected
you?
Who did you report
it to?
If given a reference
number, please
state it
What response did
you get to this
second response?
Incident Three
Date of
Incident:
What
3
happened?
Where did it
take place?
How has it
affected you?
Who did you
report it to?
If you were
given a
reference
number,
please state it
What
response did
you get to this
third
response?
Additional Information
Please provide any other information you feel is relevant
Declaration
I confirm that the information given in the above form is correct to the best of my knowledge
Name:
Date:
Signature:
If you are filling this form in online please tick this box as an alternative to a signature:
Please return the completed form to: asb@harrow.gov.uk
Or by post to:
Community Trigger
Community Protection Team
1
st
Floor
Unit 1, Central Depot
Forward Drive
Harrow
HA3 8NT
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COMMUNITY TRIGGER REFERRAL FORM (London Borough of Harrow)

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Completed 20 December 2020

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