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Incident Reporting

Please note that while we respect your right to privacy and understand that you may not wish to be contacted further at this stage, if you choose to report anonymously this will limit our availability to investigate the incident and to contact you to provide advice and support.


If you are reporting anonymously we strongly encourage you to take advantage of the many internal and external services that are provided for your support, as found at the Help and Support page.


We also encourage you to record the reference number that is attached to your form. This will enable you to follow-up on your report should you decide at a later date that you wish the incident to be investigated further.


Please be aware that we have an obligation to submit information if it is of a severe nature.



Incident Category  
Incident Type  
Incident Location --Select--
On Campus Location --Select--
On Residence Location --Select--
Location Description*
Incident Date Time AEST

We understand that you may be feeling vulnerable or unsure of details at this time so please be aware that amendments can be made to your report at a later date. Please provide us with any relevant details about the incident that you think will assist us with our investigations. This can be as little or as much information as you can remember or feel comfortable disclosing at this time.

Incident Description
Person Details
Did this incident happen to you?
--Select--
Afflicted Person Type *
Person Type
--Select--
Do you identify yourself as an Aboriginal or Torres Strait Islander?
--Select--
First Name
Last Name
DOB
Gender
--Select--
Phone
Email
Address
University ID
What Faculty/Business Unit are you a part of?
Student Type
--Select--
Where you on placement
--Select--
Have you reported this to your placement provider?
--Select--
Company Name
Reporter Type
--Select--
Do you identify yourself as an Aboriginal or Torres Strait Islander?
--Select--
First Name
Last Name
DOB
Gender
--Select--
Phone
Email
Address
University ID
What Faculty/Business Unit are you a part of?
Student Type
--Select--
Where you on placement
--Select--
Have you reported this to your placement provider?
--Select--
Company Name
Do you, or the person you are reporting on behalf of, know any other person/s involved e.g. wrongdoer?
--Select--
First Name
Last Name
Gender
--Select--
What Faculty/Business Unit are they from
Have you, or the person you are reporting on behalf of, previously reported this incident to anyone?
--Select--
Please let us know to whom you have reported this to
Have you, or the person you are reporting on behalf of, received any Medical Treatment or Counselling Support in relation to the incident?
--Select--
Where was support received from?
--Select--
Would you like to arrange an appointment with our specialist Medical and Counselling Team on campus (Bruce based staff/students only)?
Did anyone witness the incident?
--Select--
Incident Witness
Representative/Alternate Contact Details
Do you wish to nominate an Alternative Contact/Representative?
--Select--
First Name
Last Name
Relationship
Phone
Email
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