Dancer SEV Rule Break Report Form

Are you reporting a new incident or reviewing an incident ?* This field is required.CCTV operators will always be reporting an incident.

YES THIS IS A NEW REPORT

NO - THIS IS A REVIEW OF THE INCIDENT (Management only)

Originally Reported on:-

Date

Hour

Minutes

Who is completing this Report

Type your name* This field is required.

Which Dancer(s) are you reporting* This field is required.

What are you reporting* This field is required.You can select more than 1

Straddle without Bra/Underwear

Sitting without Bra/Underwear

Touching another performers genitals, anus or breasts

Contact with a customers genital area

Simulation of a sex act

Putting breasts in customers face

Exchanging contact details with a customer

Customer Dancing

Putting their Genitals too close to a customers face

Other

Where did the incident take place* This field is required.

Booth 1

Booth 2

Booth 3

Booth 4

Booth 5

Booth 6

Booth 7

Booth 8

Booth 9

Booth 10

Booth 11

Booth 12

Booth 13

Booth 14

Booth 15

Play Room

Other

Where did the incident happened.* This field is required.

Do you know what time this happened ?* This field is required.

YESNO

When did this happen ?* This field is required.

Date

Hour

Minutes

What session did this happen* This field is required.The session is the day you started your shift.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Date of review and the outcome decision

Date

Hour

Minutes

Who reviewed the CCTV* This field is required.

Were the rules Broken* This field is required.

YESNO

Describe the rule break* This field is required.

What was the outcome* This field is required.

Let the Duty supervisor know about the report. Do not discuss it with anyone else.

Please Submit the form