Incident Reporting Form 
Western Port Football Club
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Reported by; please include Name and Contact Details *
Date of Incident 
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Time of Incident
Time
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Location of Incident 
Type of Indent 
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*Please note that some incidents must be handled by the local council - in regard to structure and ground issues.

Go to Report Local Issues to Councils | Snap Send Solve
Description of Incident 
(Describe the incident in detail, including what happened, who was involved, and any other relevant information)
Can you provide details of -Individuals Involved -Witness involved - Clubs Involved 
Has the issued been brought up to a Club Official (who then asked you to complete this online form) 
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Was medical attention required? If yes, describe the extent of the injuries and treatment provided:
Was any equipment or property damaged during the incident? If yes, describe the damage.
Are there any immediate safety concerns that need to be addressed to prevent similar incidents in the future?
What recommendations do you have for preventing similar incidents from occurring in the future?
What is the expected outcome and timeline required for results?
The Western Port Football Club Committee have allocated 3 Team Members to oversee any Incidents - please be assured that any report will be handled with Privacy and Respect. *
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