• Incident and Concern Reporting Form

  • If a child or young person is in immediate danger, call 000 first. Complete this form as soon as it is safe to do so.

  • 1. Your Details (the person making this report)

  • Format: 0000 000 000.
  • Date of this report
     - -
    2 digit day, 2 digit month, 4 digit year
  • Your relationship to the Club (select one):

  • 2. What is your concern about? (select all that apply)

  • Nature of the Concern
  • Is a child or young person in immediate danger right now?*
  • If you selected "Yes" above

    Call 000 (Police/Ambulance) now, if you haven’t already.

    Then, as soon as it’s safe, contact the Child Safety and Governance Lead. If the Lead is unavailable or the concern is about them, contact the President.

  • 3. Who is involved?

  • 4. What happened?

  • Date of incident/concern
     - -
    2 digit day, 2 digit month, 4 digit year
  • Approximate time

  • 5. What would you like the Club to do?

  • 6. Your Confirmation

  • I confirm that the information provided in this form is true and accurate to the best of my knowledge. I understand that the Club will handle this report in accordance with the Complaints and Participant Protection Policy, and that confidentiality cannot be guaranteed where the law requires disclosure (e.g. mandatory reporting).
  • Date
     - -
    2 digit day, 2 digit month, 4 digit year

  • OFFICE USE ONLY

  • Date received
     - -
    2 digit day, 2 digit month, 4 digit year
  • Pathway (circle one): Child safety (Section 9) / Integrity referral / General (Section 7)
  •  
  • Should be Empty: