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Feedback/Incident Report Form
Please submit official feedback using this form.
16
Questions
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1
What is the nature of this Report?
Positive Feedback
Incident
Constructive Feedback
Near Miss
Hazard
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2
Are you a Staff Member or Parent/Athlete?
Parent/Athlete
Staff Memeber
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3
Staff Member Recording Incident/Complaint/Feedback
*
This field is required.
Lauren Erickson
Caitlyn Davison
Olivia Rogers
Abigail Erickson
Emma Erickson
Tayla Coplick
Angela Swee
Bronte Stuart
Ellie Jewell
Jordi Millward
Janelle Bastow
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4
Email
*
This field is required.
example@example.com
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5
Parent Full Name
*
This field is required.
First Name
Last Name
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6
Athlete Name
*
This field is required.
First Name
Last Name
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7
Date Incident/Feedback Occurred
*
This field is required.
-
Date
Year
Month
Day
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8
Location Feedback Relates to
*
This field is required.
Competition
Infinity HQ
Infinity Elite Gym
Other
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9
Which Staff Members does this Feedback Involve?
*
This field is required.
Lauren
Caitlyn D
Emma
Liv
Bronte
Abigail
N/A
Tayla
Jordi
Angela
Janelle
Other
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10
Please list any other people involved
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11
Please provide Feedback/Incident Details here
*
This field is required.
Please include details regarding the incident.
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12
File Upload
Please add any supporting documents or photos.
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
Browse Files
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13
Does this incident break any of our Gym Rules or Policies?
Please Select
Yes - This athlete has broken our policies so requires a PINK Slip
Yes - This athlete has broken our policies but only requires a Warning
No - This athlete has not broken our policies
Please Select
Please Select
Yes - This athlete has broken our policies so requires a PINK Slip
Yes - This athlete has broken our policies but only requires a Warning
No - This athlete has not broken our policies
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14
Have you informed the parents of the incident
Please Select
Yes - In person
No - This still needs to be done
No - A parent meeting is required
Please Select
Please Select
Yes - In person
No - This still needs to be done
No - A parent meeting is required
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15
Actions
Please add further details to the actions you have made. Including details about what you have said to the parents.
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16
Has this incident been settled or does it need following up?
Please Select
This incident needs to followed up
This incident has been followed up already with appropriate actions
Please Select
Please Select
This incident needs to followed up
This incident has been followed up already with appropriate actions
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