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Incident Report Form
Use this form to report incidents, accidents and injuries to the Kucom Theatre Committee.
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* Indicates required question
In your own words, describe what happened.
*
What were the people involved doing? Were any tools or equipment involved? What action was taken?
Your answer
Who was involved?
What role did each person play, eg they were injured, they observed the event etc.
Your answer
Where did the incident, accident or injury occur?
EG Kucom bar, dressing rooms, stage, auditorium.
Your answer
Do you have any photos or documents to help describe it?
*
Yes, I will email these to
admin@kucom.org.au
No
Required
Do you have any recommendations on how to prevent it from happening again?
Your answer
Do you have any other comments?
Your answer
Your Name
Your answer
Your contact details
Your answer
Date submitted
*
MM
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DD
/
YYYY
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