Register an Incident or Complaint

Register an Incident or Complaint

Please use this form to notify Crossroads of any:safety incidents, hazards or concerns;privacy concerns or complaintsIf you have any questions about this process please contact office@crossroads.asn.au. All reports made will be treated confidentially and seriously but please note that we may have to inform our insurance, the authorities and/or an external investigator if the details you provide require this by our policies and procedures.
Contact Details

Crossroads may need to contact you to clarify your report and in case of any investigation
Name*

First NameLast Name
Email Address*
example@example.com
Mobile Number*
Please enter a valid phone number.
Does this incident concern misconduct by any Crossroads Staff/Volunteer towards a child/youth?*

YesNo

Report

This section is only to be filled out in the case of a privacy conern
Select a type of report/complaint*
When was the hazard/concern identified, or when did the incident occur? Please be as specific as possible*
Where is the hazard located or where did the incident take place?*
Adults present or impacted (if any)
Are there any children/youth involved in this incident?*

YesNo
Please provide a brief description of the hazard/incident/concern*
Please describe any actions that have been taken so far

Children/Youth Details

This section is only to be filled out if a child or youth was involved
Children/Youth Impacted*

Other Comments
Whose information do you have concerns about?*

MineSomeone else (please specify)
What is your relationship to the person specified?*
Please provide any other details that might help in an investigation to this matter (e.g. other persons involved)
Please upload any pictures or documents that might be helpful in a possible investigation

Cancelof
Should be Empty:

Contact Details