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Domestic Abuse Form

This form is to report an incident of Domestic Abuse that has occurred within Scotland.

In an emergency always dial 999.

This form can be used if you have been a victim of domestic abuse, if you have witnessed an incident of domestic abuse or if you are reporting domestic abuse on behalf of someone else (known as a third party report).

Please complete this form with as much detail as you can.

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Remote Reporting Site Domestic Abuse Form


Your Details

Your details will be held in confidence. You do not need to provide your details; however, it may assist the police, should you choose to do so.
Scottish Police will record this incident and the appropriate action will be taken.
Please complete the sections below.

If you are not the victim, please provide the victim’s details within the section titled Incident Details.

Date of birth:
/ /

Gender Identity
(only applicable if you are the victim)
Have you ever identified as a transgender?

Details of the person responsible for the abuse (please provide all known details)



Date of birth:
/ /





Gender Identity
Have they ever identified as Transgender

Additional Information on the person responsible for the abuse

Does the person responsible for the abuse have a vehicle?

Are they involved in any other crimes?


Incident Details

Date of Incident:
/ /
Time of Incident:

What type of abuse did the incident involve? (select any which are relevant)




Victims details (if this is not you)

Date of Birth:
/ /

 


Please complete the relevant section.


If you are the victim

Do any of the following apply to you? (tick more than one if appropriate)






Have you ever reported any domestic abuse incident to the police before?

If you are a witness/third party

Do you know the victim?
Do you know the person responsible for the abuse?

Is the victim aware that you are reporting the incident?

Special Requirements

Are you willing for the police to contact you?

Would you prefer a plain clothed officer?
Would you prefer a male or female officer?

(Every effort will be made to fulfil these preferences, however cannot be guaranteed on all occasions).

Do you require an interpreter?


General Comments



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