INCIDENT REPORT
Date of Incident:
*
-
Day
-
Month
Year
Room number of complainant (if any):
Time:
*
Hour Minutes
AM
PM
AM/PM Option
Exact Location:
*
(Room number, Floor, Common room, Outdoors etc.)
Person Completing this Form:
*
(Full name, Mobile number and Email)
Person/s involved:
*
(Involvement, Full name, U-ID, Mobile number and Email)
Incident Classification:
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Accident
Behaviour / Attitude / Harrasment
Belongings in corridor
Contact from Parent
Excessive Alcohol Consumption
Lift Entrapment
Lost Property
Major Injury
Mental Health Related
Minor Injury
Noise
Non-Bedroom Access
Office Equipment Borrowing
Parcel / Mail Pickup
Posession of Illegal Substance
Residents Disputes
Smoking / Vaping
Theft
Unauthorised entry/Security Concern
Vandalism
Other
Incident Description
Accident - including broken glass in the kitchens
Behaviour / Attitude / Harassment - resident being difficult to the stafff member
Belongings in corridor - note down room number
Contact from Parent – usually for wellbeing check, door knock and inform resident to contact their parent
Excessive Alcohol Consumption – if resident made a mess (vomit/rubbish) ensure that you get their name and room number
Lost Property
Major Injury - hospitalisation, open wounds, broken or suspected broken bone/s
Mental Health Related
Minor Injury
Noise - complaint / issue re: noise inside the building or external
Non-Bedroom Access - access to Admin Office or access to the building
Office Equipment - trolleys, iron, vacuums etc.
Parcel / Mail Pickup (urgent only)
Possession of Illegal Substance (incl. marijuana, NOS, etc.)
Resident Disputes – quarrel and misunderstandings
Smoking/Vaping
Theft – belongings, food in kitchen
Unauthorised entry / security concern – external door left open, unhoused person in building
Vandalism - intentional damage such as graffiti, smashed wall etc.
Incident Summary:
*
Please provide detailed summary of the incident including actions taken.
List Residential staff involvement/escalation:
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(Resident Advisor, Admin Staff, Residential Life Manager or other Residence Management)
Were there any other agencies involved in this incident?
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(Police, Ambulance, Fire services, Access ACT Health)
Additional comments:
All incidents will be followed up by Senior Managers and may involve a debrief. Please advise if you would like an immediate debrief the morning/afternoon from the incident:
*
Yes
No
Are there any additional documents in relation to this incident?
*
Yes
No
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