ACS DRAFT ONLY | Internal Incident Report Non Medical

Draft Only

To be reviewed by management
Internal Incident Report Details

Non-medical
Venue Incident Occurred*
Person Completing Report*

First NameLast Name
Person Completing Report Email*
Please enter the venue email above - lifeguards@orionlagoon.com.au
Date*

DayMonthYear
Time

:HourMinutesAM/PM Option
Upload Photo of area - include any relevant signs, safety warnings, hazards that caused the incident etc.

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The Incident
Alleged AssaultAlleged TheftDangerous EventWHS IncidentOther
Description of incident - Detailed description. Include time, how the incident occurred and factors that may have contributed. *
Location inside venue - give as much detail as possible*

The Response
Please list staff involved and their position *
Name/Position (John Smith - Duty Manager)
Explain in detail the action taken by staff.*
Point form.
Were the emergency services called?*
PoliceFireAmbulance
If Yes
Time Called

:HourMinutesAM/PM Option
Time Arrived

:HourMinutesAM/PM Option
Time Departed

:HourMinutesAM/PM Option

Internal Incident Report Details