Making a personal data request under the Data Protection Act

Your name *

Email *

Address *

Postcode *

Contact number *

I am requesting for...

A public body (police, HMRC, CQC, H&S executive)

A utility company

On behalf of someone (local authority, solicitor, relative, healthcare professional, social worker, carer)

Information about myself

Requests from public bodies

Under Schedule 2 of the Data Protection Act 2018 please use this form where access to personal data is required for the following purposes *

The prevention or detection of crime

The apprehension or prosecution of offenders

The assessment or collection of tax or similar

I require access to the following personal information (for CCTV please include date, time and location. Please note requests may take up to 14 days): *

This information relates to the following data subject

Name

DOB

Midland Heart address

Reason for your enquiry *

By completing this form

I confirm that the personal data requested below is needed for the purposes indicated above and a failure to provide that information will be likely to prejudice those matters. *

I confirm that the individuals whose personal data is sought should not be informed of this request as to do so would be likely to prejudice the matters described above. *

I confirm that the personal information provided to me by Midland Heart will only be used for the purpose specified on this form and will not be passed to other third parties without express written permission being obtained from Midland Heart first. *

Name *

Designation *

Senior official, name and designation (police only)

For and on behalf of

Request from utility company

Your Company *

Utility your company provides *

Address your enquiry is about *

Information you are seeking *

Requester details:

There will be circumstances under which personal data about you either cannot be provided to you or is not necessary to be disclosed to you. Your name being within information does not necessarily make that information your personal data.

For example:

a complaint made about you may not be disclosed to you because the individual who made the complaint has rights. One right is the expectation of confidentiality, which may override your own rights
information that contains your contact data (name, address, telephone number, email address) but where the information is predominantly about your home, such as repairs and services carried out in your property

Making a request for copies of your personal data will not provide:

Copies of documents - for example but is not limited to: tenancy agreements, letters, statements, certificates, payslips

Property data - for example but is not limited to: repairs, services, disrepair, surveyors’ reports

Safeguarding information - for example but is not limited to: reports about anti-social behaviour (ASB), conflict resolution, the well-being of individuals

Information about other individuals, such as your neighbours and colleagues or complaints or witness statements made by those individuals

Copies of original documents that we hold, such as those we have received to support your benefit application; health information which has been sent to us from your GP; correspondence you already have from agencies such as the police, social workers or local authorities; references received from your previous employers or landlords

Current and former employees:

Reviews, payslips, certificates, absence requests and training records are documents which have been made available via the employee portal or by making a request to HR.

The Information Commissioner’s Office definition of personal data can be found here: https://ico.org.uk/for-organisations/guide-to-data-protection/guide-to-the-general-data-protection-regulation-gdpr/what-is-personal-data/what-is-personal-data/

Our privacy notice can be found here: https://www.midlandheart.org.uk/privacy-notice/

Please tick the box below to say that you have read and understand all of the above

I have read and understood all of the above *

Your relationship to data subject *

Designation *

For and on behalf of (organisation) *

Are you requesting for a tenant or an employee? *

Tenant

Employee

I am requesting access to the following personal data *

Please specify date(s) or date range and reference numbers *

Data subject's details:

Their name *

All Midland Heart addresses *

DOB

Date when you last made a similar request to us (if applicable):

I hereby confirm the above information is correct *

Please attach your form of authority to act on behalf of this individual *

For example:

a complaint made about you may not be disclosed to you because the individual who made the complaint has rights. One right is the expectation of confidentiality, which may override your own rights
information that contains your contact data (name, address, telephone number, email address) but where the information is predominantly about your home, such as repairs and services carried out in your property

Making a request for copies of your personal data will not provide:

Copies of documents - for example but is not limited to: tenancy agreements, letters, statements, certificates, payslips

Property data - for example but is not limited to: repairs, services, disrepair, surveyors’ reports

Safeguarding information - for example but is not limited to: reports about anti-social behaviour (ASB), conflict resolution, the well-being of individuals

Information about other individuals, such as your neighbours and colleagues or complaints or witness statements made by those individuals

Current and former employees:

Reviews, payslips, certificates, absence requests and training records are documents which have been made available via the employee portal or by making a request to HR.

Our privacy notice can be found here: https://www.midlandheart.org.uk/privacy-notice/

Please tick the box below to say that you have read and understand all of the above

I have read and understood all of the above *

Are you a tenant or employee? *

Tenant

Employee

Your previous address(es) if moved in last 3 years

DOB *

These are examples, there may be personal data that lawfully cannot be disclosed to you. Information provided to us from third parties may not be disclosed to you.

Your own complaint data - Your own ASB/Case file data - Supported/Retirement Living notes - Money Advice information - Income team notes - Customer Services notes - Housing team notes - Lettings notes - Telephone recordings - Emails about you - Health data relating to your aids/adaptations works

These are examples, there may be personal data that lawfully cannot be disclosed to you. Information provided to us from third parties may not be disclosed to you.

HR File: (includes: disciplinary, capability, absence management, sickness certificates, occupational health notes, contract) - Emails: about yourself - Instant Messages: messages about yourself (you must provide all relevant email addresses including your own. We are unable to provide mobile phone messages)

I am requesting access to the following personal data *

Date range for personal data being requested *

Relevant telephone numbers/email addresses/online usernames

I hereby confirm the above information is correct *

Consent for storing submitted data *

Yes, I give permission to store and process my data