Appealing against the outcome of Local Resolution or the
outcome of a complaint after the decision to disapply
Section 1: Your details :
Personal details:
Title:
First name:
Surname:
Date of birth:
Address details:
House/flat number:
House/building name:
Street:
Town:
County :
Postcode:
Contact details:
Email address:
Main contact number:
Alternative contact
Number:
Section 2: Would you like some one to act on your behalf?
Please tick as appropriate:
Yes, I would like someone to act on my behalf :
No, I don’t want someone to act on my behalf:
If you selected yes, please provide the contact details of the person acting on your behalf:
Personal details:
Title:
First name:
Surname:
Date of birth:
Address details:
House/flat number:
House/building name:
Street:
Town:
County :
Postcode:
Contact details:
Email address:
Main contact number:
Alternative contact
number:
Section 3: Your appeal details
Please enter the details of the appropriate authority that dealt
with your complaint:
If you received a letter from the appropriate authority telling
you about the outcome of your complaint please give the date
of that letter:
Date you made your complaint:
Appropriate authority reference number ( if known) :
______________________________________________________________________________
Please tell us why you would like to appeal about the way your complaint was handled by
answering the appropriate selection below:
This appeal relates to :

the outcome of a complaint dealt with by Local Resolution:

the outcome of a complaint after the decision to disapply :
If your appeal relates to the outcome of a complaint dealt with by Local Resolution please
answer the following questions:
Q: Do you agree with the outcome of the complaint dealt with by
Local Resolution?
YES / NO
If the answer to the above is no, please provide further information ( continue on a separate
sheet if necessary):
Q: Was the outcome a proper outcome?
YES/ NO
This means that, for example, you believe the outcome was not appropriate to the complaint,
or the outcome did not reflect the evidence available.
If the answer to the above is no, please provide further information ( continue on a separate
sheet if necessary):
If your appeal relates to the outcome of a complaint after the decision to disapply please
answer the following questions:
Q: Do you agree with the outcome of the complaint after the decision to disapply:
YES/ NO
If the answer to the above is no, please provide further information ( continue on a separate
sheet if necessary):
Q: Was the outcome a proper outcome :
YES/ NO
This means that, for example, you believe the outcome was not appropriate to the complaint,
or the outcome did not reflect the evidence available.
If the answer to the above is no, please provide further information ( continue on a separate
sheet if necessary):
If you have a letter from the appropriate authority about your complaint outcome or any other
documents that support your appeal please attach them to this form when submitting your
appeal.
Section 4: Confirmation and signature
Please provide your signature to confirm the information you have provided is correct:
Signature:
Date:
Section 5: Ethnic Group
Please tick as appropriate:
White - British
White - Irish
White - Any other background
Mixed Mixed Mixed Mixed -
White and Black Caribbean
White and Black African
White and Asian
Any other Mixed background
Asian or Asian British - Indian
Asian or Asian British – Pakistani
Asian or Asian British – Bangladeshi
Asian or Asian British - any other Asian background
Black or Black British - Caribbean
Black or Black British - African
Black or Black British - Any other Black background
Chinese or other ethnic group – Chinese
Chinese or other ethnic group – Any other ethnic group
Not stated
Please return this form to:
Cleveland Police
Professional Standards Department
Shared Service Centre
Ash House, III Acres
Princeton Drive
Thornaby
TS17 6AJ