Community Trigger Form

Please complete fully so that an assessment can be made as to whether the threshold for a review has been met.

Please provide us with your contact details: we need to be able to keep in contact with the person who is requesting the case review.

This will be the point of contact for all correspondence throughout the case review process.

Your name
Gender

Your age
Organisation / group (if applicable)
Position in organisation / group (if applicable)
Your address
Your postcode
Email address
Your contact number
Your preferred contact method


If you are representing a victim(s), you must have signed consent to request a case review. If you are acting on behalf of the victim, we will need to see their written permission as well as written confirmation that they are happy for information regarding their case to be shared with you. Please confirm where that signed permission and consent can be obtained.

Victim’s name (if different to above)
Victim’s address (if different to above)
Each incident must have been reported to one of the following organisations; North Wales Police, North Wales Local Authority, Housing Association, Local Health Board E.g. all three incidents may have been reported to North Wales Police or two incidents may have been reported to North Wales Police and one to Wrexham Borough Council Each incident must have been reported within one month of it occurring and all three incidents must have taken place in the last 6 months. Please provide as much information as possible.
INCIDENT 1 - Date and time
Brief details including location
Reported to - name (if known)
Reported to - organisation



Incident or reference number (if known)
Date and time of report
Method of initial reporting



Action taken by whom
INCIDENT 2 - Date and time
Brief details including location
Reported to - name (if known)
Reported to - organisation



Incident or reference number (if known)
Date and time of report




Action taken by whom
INCIDENT 3 - Date and time
Brief details including location
Reported to - name (if known)
Reported to - organisation



Incident or reference number (if known)
Date and time of report




Action taken by whom
The more information you provide in this section, the better understanding the case review meeting will have of the current situation and your expectations of solution.
Please could you explain why you are unhappy with the action that has been taken?
What would you like to see done to resolve the issue?
Are you currently receiving support from any agency in relation to these incidents? What other agencies do you think can help to resolve the problem? Please provide details
Any other information you would like to provide in relation to the incidents?
“As a victim of the incident(s) indicated on this form, I confirm that the details provided by me within this form are accurate and I understand that those details may be shared will other agencies involved in this process.”