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Incident Report Form
STRICTLY CONFIDENTIAL

• The form should be filled out shortly after any incident.
• Not all questions may be relevant to all incidents, but as much detail as possible should be given.
• Please avoid or indicate any confidentiality issues, since the form is to be sent to relevant people in order to
adequately look into the matter.
• This form enables you to send a report safely and confidentially. You do not have to write your name anywhere in this
report. However, if you would like us to respond to you please indicate your name and email address below.
• If you have identified yourself and provided contact information, we will endeavour to respond to you as soon as
possible, and no later than one month after receipt of your report. If required, we may request more information.

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