Public Portal

Complete if you are a witness, were in the factory at the time of the fire, or have any information you think may be relevant please use this form.

SURNAME *

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FORENAME *

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AGE/DATE OF BIRTH *

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YOUR ADDRESS

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YOUR TELEPHONE NUMBER/S *

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YOUR EMAIL ADDRESS

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WERE YOU INJURED AS A RESULT OF THE INCIDENT? *

YES NO

IF YES, PROVIDE DETAILS OF YOUR INJURIES:

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SELECT ONE OF THE FOLLOWING OPTIONS *

IF YOU HAVE RECEIVED TREATMENT PROVIDE DETAILS OF TREATMENT RECEIVED AND WHERE YOU WERE TREATED. INCLUDE ANY PATIENT REFERENCE NUMBER YOU MAY HAVE..:

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WHAT IS YOUR NATIONALITY?

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IF YOU ARE NOT A BRITISH NATIONAL, HOW LONG HAVE YOU BEEN IN THE UK?

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WERE YOU WITH ANYONE ELSE AT THE TIME OF THE INCIDENT? *

YES NO

IF YES, PROVIDE AS MUCH DETAIL AS POSSIBLE, E.G. NAME/ADDRESS/CONTACT NUMBER/AGE/LOCATION NOW/LOCATION AT TIME OF INCIDENT:

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1. DO YOU HAVE ANY INFORMATION THAT COULD SAVE LIFE OR IDENTIFY A SUSPECT? *

YES NO

IF YES, PLEASE PROVIDE DETAILS:

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2. HAVE YOU HAD PHYSICAL CONTACT WITH ANYONE YOU BELIEVE COULD BE A SUSPECT? *

YES NO

IF YES, PLEASE PROVIDE DETAILS:

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3. DID YOU SEE ANYONE ELSE BEING INJURED? *

YES NO

IF YES, WHERE WERE YOU? WHAT DID YOU SEE? WHO WERE YOU WITH?

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4. DO YOU HAVE ANY MEDIA FOOTAGE OF THE INCIDENT? (RECORDINGS/ PHOTOGRAPHY/ VIDEO)? *

YES NO

IF YES, PROVIDE DEVICE DETAILS WHERE FOOTAGE IS RECORDED (E.G MOBILE/CAMERA/TABLET),

Maximum 700 megabytes file size allowed

ALTERNATIVELY UPLOAD ANY FOOTAGE VIA UKIMAGEAPPEAL.COM OR UKIMAGEAPPEAL.CO.UK

IF YES, PROVIDE DEVICE DETAILS WHERE FOOTAGE IS RECORDED (E.G MOBILE/CAMERA/TABLET):

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IF YES, HAS FOOTAGE BEEN UPLOADED ONTO SOCIAL MEDIA?

YES NO No Answer Given

IF YES, ON WHICH SITE? (FACEBOOK/TWITTER/INSTAGRAM?):

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IF YES WHAT IS USERNAME OF PERSON UPLOADING IT?

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USE SPACE BELOW TO PROVIDE ANY OTHER INFORMATION YOU THINK WE SHOULD BE AWARE OF:

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THANK YOU FOR YOUR INFORMATION. YOU WILL BE RECONTACTED BY AN OFFICER FROM THE INVESTIGATION IN DUE COURSE.

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