CentreStage Incident Report Form
At CentreStage, we live and breath our value every day. We understand that near misses, mental health report and physical injuries may occur. We have a strong RSA plan to reduce the risk associated with CentreStage.

We treat every incident as a priority. In some circumstances, Incidents/near misses may require third party intervention including Department of Human Services or Department of Education. We encourage you if you ever feel unsafe to contact marnie@centrestage.org.au

A copy of this form is automatically sent to our senior management team to action.
Email address *
Untitled Title
Name of Individual completing form *
Phone Number of individual completing form *
Email contact of individual completing form *
Date of Incident/Near miss *
MM
/
DD
/
YYYY
Individual/s concerned with incident *
Contact phone number of individual *
Email address of individual *
Location of Incident *
Activity undertaken prior to incident (Ie dancing, Audience member, vocal) *
Description of Incident: *
Please explain body parts injured *
List of individual/s who applied first aid and qualifications if available *
Description of First Aid Provided *
Was the Individual offered an ambulance? *
Did the individual refuse ambulance service? *
Please list additional notes to assist executive team
Please email image of injury to marnie@centrestage.org.au
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of CenterStage. Report Abuse