Women and Girls Public Safety Reporting Form

This is where you can have your say on public spaces and places that you feel are unsafe. This may include practical concerns such as dark walkways or overgrown public paths where visibility is poor.

The information will then be collated and appropriate action will be undertaken to make improvements where possible.

Where Are You?
1. Please ensure location services are active on your phone/browser. You can check your location is correct once highlighted on the map.
2. What is your location?*
  
  Enter address or postcode if the map cannot locate you
3. Please provide a description of the location*
  Please provide as much detail of the area, were you in a street? At a bus stop? or any other information you can.
When did you feel unsafe?
1. Date
2. Approximately what time did you feel unsafe?
Further Information
1. Why did you feel unsafe?*
  You can enter up to 50000 characters
2. What made you feel unsafe?*
  You can enter up to 50000 characters
3. What would make you feel safer?
  1. Improved Lighting
  2. Trimmed trees/bushes/shrubbery
  3. CCTV camera
  4. Improved lighting to underpass
  5. Other
4. Please detail what other ways that could make you feel safer?
  You can enter up to 50000 characters
5. Would you like to receive a personal alarm?
  
  Yes
  
  No
  Please note: You will be asked for contact details to contact you about how you can get a personal alarm
Contact Information
1. Name
2. Telephone Number
3. Email Address
5. Please check the box if you would like to be part of future surveys about Women and Girls Safety
6. Please check the box if you would like to be part of future focus groups about Women and Girls Safety
1. How did you find us?
2. Did you find this useful?
  
  Yes
  
  No

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Women and Girls Public Safety Reporting Form