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Toggle Navigation
Welcome
Principal’s Welcome
Why a Girls-Only School
College Heritage
Mission Statement
College History
College Governance
Strategic Plan
College Leadership Team
Admissions
Why a Brigidine Education
Brigidine Role Models in the Community
Lyma Nguyen
Dr Devini Ameratunga
Jacinta Stewart
Dr Ambereen Khan
Book a Tour
Enrolling at Brigidine
Enrolling Online
College Fees
College Prospectus
Scholarships
Bursary Fund
Beginning at Brigidine
Learning with Care
Education at Brigidine
Our Catholic Identity
Religious Education
Brigidine Education Philosophy
Programs of Excellence
Brigidine Curriculum
Year 5-6
Year 7-8
Year 9-10
Year 11-12
VET
Work Experience
Student Wellbeing
Formation Program
The House System
Student Leadership
Counselling and Careers
Positive Relationships
Cocurricular
Sports
Arts
Arts Sign On
Service
Be Brave. Be True. Be You.
Our Community
Policies and Reports
Parent/Guardian Resources
IT Support
Stationery Lists
Facilities and Services
Brigid’s Cloak
Curragh Café
The Marian Centre
Tullow Resource Centre
Book Room
Brigid Centre
Book a Facility
Transport
Brigidine College Business Directory
Parents and Friends’ Association
Alumnae
Remain Connected
Reunions
Brigidine Alumnae Awards
The Brigidine Link
News & Events
College News
College Events
College Publications
Video Gallery
College Live Streams
College Calendar
Term Dates
Careers
Why join us?
Pre-Service Teacher Fellowship
Mandatory Staff Training
Current Opportunities
Contact Us
Incident Form
Incident Form
4sure
2022-08-18T09:08:07+10:00
Incident Reporting Form
Step
1
of
2
50%
Details of Person Completing Form
Reporter Status
*
Employee
Contractor
Student
Parent/Carer
Work Experience
Volunteer
Member of the Public
Reporter Name
*
First
Last
Reporter Email
Reporter Phone Number
Details of Person Involved in Incident
(One form per person involved)
Status of Person Involved in Incident
*
Employee
Contractor
Student
Parent/Carer
Work Experience
Volunteer
Member of the Public
Name
*
First
Last
Contact Phone
Email
Date of Birth
MM slash DD slash YYYY
Address
Street Address
Address Line 2
City
State / Province / Region
Postal Code
Additional Information
Person involved is under 18
Guardian Name
First
Last
Guardian Phone Number
Hidden
Student Year Level
Please enter a number from
7
to
12
.
Department
Position
Witnesses to the Incident
Witness Information
First Name
Last Name
Contact Phone number
Contact Email
Incident Type
Hazard
Near Miss
Injury/Illness
Click here for more information on Incident Types
Incident Description
Describe what happened
*
Location of the Incident
*
Nature of Activity
Co-Curricular Sport
Co-Curricular Arts
In Class
Outside school hours
Break time
Date of Incident
*
MM slash DD slash YYYY
Time of Incident
*
:
Hours
Minutes
AM
PM
AM/PM
Additional Incident Details
Classification of Injury/Illness
Please choose an option
Slips, Trips and Falls
Hitting object with part of the body
Being hit by a moving object
Sound, pressure
Body stressing (soft tissue/repetitive movement)
Heat, electricity
Environmental Factors
Chemicals or other substances
Biological factors
Psychological
Other
Property Damage or Loss (inc. financial)
Please choose an option
Fire
Explosion
Flood
Storm
Hail
Theft
Malicious damage/vandalism
Accidental damage
Machinery breakdown
Damage in transit
Power surge
Glass/windscreen damage
Hit by Object
Reversing
Burst Pipes
Damage while parked
Nature of Injury
Please choose an option
Laceration/Contusion/Superficial
Concussion
Sprain/Strain
Fracture/Dislocation
Exposure to Hazardous Substances
Psychological Injury
Other
Location of Injury (e.g left wrist)
Treatment Provided
Please choose an option
None
First Aid
Doctor
Ambulance
Out-patient
In-patient
Address/Location of Treatment
Details of Action Taken After Incident
Action Taken
Actioned By
Date Actioned
Time am/pm
Notes - any other relevant information to be added here
Attachment
Max. file size: 15 MB.
Use to add an attachment. e.g. an additional form about the incident that has been completed by a third party.
40305
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