Neighbours Questionaire After a Property is Brought Back Into Use

Address

Postcode

When the property was empty, did you experience any of the following ?

Rubbish dumped in the gardens

Yes
No

Vermin i.e Rats

Yes
No

Incidents of anti social behaviour

Yes
No

Damp to your property

Yes
No

Are you experiencing any of the above problems now ?

Yes
No

If the answer is "Yes", please give details

Since the property was re-occupied, how would you describe your living conditions

Much Better
Better
The Same
Worse

If it is worse, please give details

Please add any other information, you feel would be helpful

Your details (you can leave this blank if you wish to remain anonymous)

Name

Address

Post Code

Telephone Number

Email Address

Extra Information about you

The information requested below is optional and we will respond to your feedback whether or not you answer these questions.

Your answers will help us to ensure that we provide fair and continuously improving services for all our customers, and will only be used by us for monitoring and assessment purposes.

Gender:

Male
Female

Do you consider yourself to be disabled ?

Yes
No

What do you consider to be your ethnic origin ?

White

British
Gypsy/Traveller
Irish
Other White background

Please State

Mixed/Dual Heritage

White & Black Caribbean
White & Black African
White & Asian
Other Mixed Background

Please State

Asian or Asian British

Indian
Pakistani
Bangladeshi
Other Asian Background

Please State

Black or Black British

Caribbean
Somali
Other African Background
Other Black Background

Chinese

Other Ethnic Group

Yemeni
Other Ethnic Group

Please State

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