Incident Report

MGC Incident Report Form

Melbourne Gymnastics Centre
This form must be completed as soon as possible after the occurance of an incident.

Complete with as much detail as possible. All incident reports must be securely stored.

Please submit once complete and the report will be emailed the the centre manager for followup within 24 hours.

If you believe a child is at immediate risk of abuse please phone 000
Name(s) of Athlete involved:
Name of staff Member Involved:
Date the incident occurred:

MonthDayYear
Date
Time of Incident:
Centre Location:
Location of incident:(i.e. floor, bars, rings)
Class Name:
Please categorise the incident:
Please describe the incident (what did you see?) (What occurred?)
What immediate steps did you take to resolve the incident?
Did the athlete rejoin class following the incident?

Other
Did you talk with parent/emergency contact following or during class?

Other
Manager advised (either in the gym or via txt/phone)
Manager Name & Details of contact made
Other Information:
Does the athlete/staff member identify as Aboriginal or Torres Straight Islander?
- OFFICE USE ONLY
  
  Centre Manager to complete
- Date report received:
- Team member following up incident
- Follow up date/result:
- Contributing factors to the incident:
- What steps will be taken to limit risk in future?
- Has the incident been reported?
  
  Other
- Should be Empty:

MGC Incident Report Form