Report an Incident
An incident is any event or situation that results in or has the potential to result in illness, injury, or damage to people, property, equipment, material, vehicles, or the environment. It also includes any incidents or issues relating to a Social Carer or Member's overall safety and well-being.

In the event you are involved in or become aware of an incident as defined above, you must report it to Like Family so that we can take appropriate action to ensure the ongoing safety of our community members.
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Email *
First Name *
Last Name *
Phone Number *
You are a *
Did the Incident take place during a booking? *
If Yes, what is the name of the Member or Social Carer you were on the booking with?
Date of Incident: *
MM
/
DD
/
YYYY
Time of Incident: *
Time
:
Location of Incident: *
Details of Incident: *
Did any of the following take place after the incident? *
Required
Details of injuries sustained during the incident (if any)
Details of witnesses (if any):
Declaration
By submitting this form, I declare that the information I have provided herein is truthful and accurately represents the nature of the incident that took place, according to my recollection. I also approve the release of details from this form to approved authorities which may include medical practitioners, legal representatives, employee associations, insurance companies and Like Family Pty Ltd.
A copy of your responses will be emailed to the address you provided.
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