WAMSS Incident Reporting Form

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Dear WAMSS event attendees,

Please use this form to report incidents during WAMSS events that you have attended. Every report will be reviewed and considered for escalation to a meeting with the WAMSS Executive and Event Organisers, with your permission. You may remain anonymous, however we may need to contact you for more information. How contactable you are may impact the likelihood of escalation.

Your response to this form will be accessible and regularly reviewed by WAMSS President and Vice President Welfare (see below). Any information provided in this form will remain confidential, and only shared with your permission if you wish to escalate the issue. If you feel uncomfortable utilising this form due to who has access to it, feel free to email any one of us below. Responses in this form are deleted at the end of each year, given the issues have been addressed.

CONTACTS:
President: Andrew Chang, MD3 (president@wamss.org.au)

Vice President Welfare: Iley Johnson, MD3 (vpwelfare@wamss.org.au)

Thank you for reporting this incident, and we hope to be able to provide support to you as well as to address the issues to ensure that this does not happen at future WAMSS events.

If you would like to provide generic feedback for the event that you attended, please use our Feedback Form instead: https://forms.gle/VhjBs4jMos74jkFAA

Name

For us to contact you for clarification and/or follow up - you may remain anonymous if you wish

Which event did this occur at? *

Nature of incident *

Injury

Illness (physical or psychological)

Harassment or bullying (please provide names of victim and perpetrator if appropriate below)

Disrespect or intimidation of volunteers

Sexual assault

Other:

Required

Please describe the incident in detail *

Please include all names of anyone involved if you are comfortable to do so

Any other comments, questions or concerns (including desired immediate outcome)?

Submit

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