Anonymous Feedback & Incident Reporting
Our website should have directed you to this form. Please know that everything you submit here is *strictly* confidential. Your safety and comfort is our number one priority.
Sign in to Google to save your progress. Learn more
Please describe what happened, as much as you are comfortable to do so.
When did this happen?
MM
/
DD
/
YYYY
Where did this happen?
Is there anyone who was a witness to the incident?
Do you wish to remain anonymous?
Clear selection
*OPTIONAL* Your Name
*OPTIONAL* Your Email/Contact Information
Can we contact you to ask further questions about this incident?
Clear selection
Are there are specific actions you would like us to take to make you feel more comfortable in the future?
Anything else we should know?
Please know that you, your experiences and concerns are deeply valued and entirely valid. We will be doing our utmost to ensure the safety and comfort of our community and community members. If you would like further support, please reach out to some of the support services below;
Sexual assault support services:
If you have experienced sexual assault or sexual harassment and feel you would like to speak to someone for support or information, 1800RESPECT (Phone: 1800 737 732) can provide counselling 24-hours a day, 7 days a week.

Bravehearts
Ph: 1800 272 831
Website: www.bravehearts.org.au

Mental health support services:
Lifeline
24-hour crisis support and suicide prevention.
Ph: 13 11 14
Website: https://www.lifeline.org.au/ 

beyondblue
Mental health support.
Ph: 1300 224 636
Website: https://www.beyondblue.org.au/

Headspace
Supports young people aged between 12 and 25 years of age.
Ph: 1800 650890
Website: https://headspace.org.au/ 

Suicide Call Back Service
Ph: 1300 659 467
Website: https://www.suicidecallbackservice.org.au/ 
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Swing Out Adelaide. Report Abuse