This form should be used for incidents that happen during class or work time. You will need to use your judgment as to assess the seriousness of the incident. It may be appropriate to immediately call the Studio Manager before submitting this form, particularly if you are concerned for a student's safety or your own safety. Incidents can be stressful and sometimes traumatic, it is important you reach out if you feel you need support after an incident.
Name of person completing the report
This will usually be the class teacher
Please insert your Speak Up email address
Class details/location of incident
Venue (eg. Red Hill studio), Program (eg. Storytellers), Teacher (eg. Miss Olivia)
Insert the name of your teacher mentor, if you are a teacher mentor leave this field blank
Date of incident
Time of incident
Include any students, parents, school staff or Speak Up staff that were involved in the incident
Description of Incident
Please include as much detail as possible
Summary of events prior
What were the events leading up to the incident?
Description of incident
Immediate action taken
What did you do in the moment to mitigate risk?
What can we do going forward to ensure the risk of this happening again is minimised?
Suggested follow up
Have you addressed this incident with the studio yet?
No, I am using this report to notify the studio
I have already discussed it with my teacher mentor or team leader
I have already discussed it with the studio manager or director
What can Speak Up do to support you and ensure you are okay after this incident?
I would like to chat with my teacher mentor or team leader
I would like to speak with the studio manager or director
I would like to speak with a psychologist or counsellor
I don't need any further support
Should be Empty: