Anti-Social Behaviour Diary Sheet
Please note that any information you give on this form may be shared with partner agencies in order to help prevent or detect crime. This will be done in strict confidence without revealing your identity. Also your information will not be used in legal proceedings without your permission. Please use back of sheet if necessary.
Once completed please return to:
Anti-Social Behaviour Caseworkers, Community Safety,4th FloorEast, 64 Victoria Street, London SW1E 6QP.
Alternatively you can scan and email the completed form to
Your Name and Address: / Joanna Bloggs123 Westminster Way
Exact location of incident: / Westminster Way jct with Windsor Palace Gardens
Names/description of
those involved: / 5 white adult malesage approximately in the 30’s
Male 1 – cropped dark hair wearing blue jeans and grey jacket with a large rip on the back
Male 2 – blonde hair with long fringe wearing black trousers and a blue jacket with a nike tick on the right arm
Date: / 17th March 2016 / Start time: / 23:37 / End time: / 02:43
Description of incident (provide exact details of what you saw and heard using the actual words spoken)
The five men were hanging around outside my house, they were shouting and swearing, goading each other into fighting. One had what looked like a wooden broom handle, and others were throwing cans and bottles at neighbouring cars. They were shouting ‘f**k them all, they don’t tell us what to do. No one can, we can go wherever we f**king want’. They had managed to get hold of a road cone and kept throwing it into the road as cars were driving past then retrieving it and repeating it.
I went outside and asked them to stop using this kind of language as my children were frightened and had been woken up, the man with the cropped black hair came forward and his face was an inch away from mine and he said ‘don’t f**k with me, I know where you live and I can come back when you take your kids to school’
I asked again if they could just move along and they just laughed at me. This happens most Friday and Saturday evenings, they seem to get their alcohol from the local Tesco store so perhaps someone can speak to them about selling drink to these people?
They appear to be homeless and walk down my road to go to the park where I think they sleep.
How has this affected you? (write down the way this incident has made you feel. Include its effect on
people who live with you, e.g., has it stopped you sleeping, frightened your children, etc.)
My children were woken up on 3 separate occasions they were very frightened and thought that someone was going to hurt me. I could not get back to sleep for almost 2 hours and my work is being affected due to the interrupted sleep. The school has called me in to tell me that my children are yawning at school during lessons and my daughter in particular has spoken to the welfare nurse and told her she is scared to go to sleep at night now.
I believe that the information above is a true description of what I saw and/or heard
Print Name: Joanna Bloggs Signature:
Date: 21/03/2016
* The writing above in blue is an example of the level of information that is required when completing this form