Incident Reporting

If you or somebody at a u3a activity has an incident you can use this online reporting form. If you prefer a paper version you can download a copy from the help and support page.

Click here to see all incident reports

Incident Type

Select the category that best describes this incident. Choose one option only.

Damage to Property Injury Near Miss

Incident Title

Provide a brief, descriptive title for this incident (e.g. "Broken window in reception" or "Slipped on wet steps at main entrance").

Incident Title *

Injured Party / Person Involved

Enter the full name and contact phone number of the person who was injured, or the person who caused the damage. If unknown, write "Unknown".

Full Name *

Phone Number *

Witnesses

Enter the name and phone number of any witnesses to the incident. You may record up to 3 witnesses. Leave blank if there were no witnesses.

Witness 1

Full Name

Phone Number

Witness 2

Full Name

Phone Number

Witness 3

Full Name

Phone Number

Date and Time of Incident

Select the date and time when the incident occurred. The date defaults to today. Adjust if the incident happened on a previous date.

Date *

Time *

Location of Incident

Enter the full address where the incident took place, including the postcode. Be as specific as possible (e.g. include floor, room, or area within a building).

Address *

Postcode *

Details of Incident

Describe what happened in as much detail as possible. Include what you saw, heard, or found. State the sequence of events leading up to, during, and immediately after the incident.

Incident Details *

Immediate Action Taken

Describe any action that was taken immediately following the incident (e.g. first aid administered, area cordoned off, emergency services called, damaged item removed). If no immediate action was taken, write "None".

Immediate Action *

Person Completing This Report

Enter your full name and contact phone number. This is required so that further information can be requested if needed.

Full Name *

Phone Number *

Follow-up Action

If known at the time of reporting, describe any follow-up actions to be taken. Include a target date and time. This can also be completed later by viewing the report within 24 hours of submission.

Incident Reporting

Incident Type

Incident Title

Injured Party / Person Involved

Witnesses

Witness 1

Witness 2

Witness 3

Date and Time of Incident

Location of Incident

Details of Incident

Immediate Action Taken

Person Completing This Report

Follow-up Action

Report Submitted Successfully