Tickit on Demand - Australian College of Theology

Critical Incident Report Form

Use this form to report a Critical Incident to the ACT Office. The form involves two phases.

Phase 1: Initial reporting of the incident as soon as practicable after the incident occurs. This is to be completed by the person responsible for managing the incident or their delegate.

Phase 2: Final reporting once the college's planned responses have been completed. This is completed in Tickit by the college's Tickit User after consultation with the person who was responsible for managing the incident.

Note that the form can be saved as a draft and edited before submitting it to ACT. If the form is completed using the weblink, after saving as a draft you will get a link to re-open the draft. Anyone with the link will be able to open and edit the draft until it is submitted.

Your Name^*

Your Email^*

Your phone number

Date Occurred

Time Occurred

College^*

Initial Reporting of Incident (Phase 1)

Submit this section of the form as soon as practicable after the incident has occurred.

Are you the best person to contact regarding the management of the issue at the college?

YesNo

If no, please provide the name, position, and contact details for the preferred contact at the college^*

Please tell us about what happened and how the college has responded to the present time^*

What further action has the college planned in response to the incident?^*

Does the incident involve an alleged or possible instance of sexual assault or sexual harassment?

YesNo

Does the incident particularly concern any of the following? ^*

Select all that apply

Has the incident been reported to emergency services, a government department, or any other organisation?^*

YesNo

If yes, please provide details^*

Has the college been approached by any media agency regarding the incident?^*

YesNo

If the college has been approached by any media agency, please provide details^*

How can the ACT support the college in responding to the incident?

Any other comments on the incident

Thank you for completing the initial reporting phase of the form. Please press 'Submit Form Details'. You may attach supporting evidence documents after submitting (e.g. an incident report produced by the college).

Note: If you are completing the form logged in to Tickit you may add evidence documents BEFORE you submit.

Attach Evidence Documents

Add another Document

Critical Incident Report Form

Initial Reporting of Incident (Phase 1)

Thank you for completing the initial reporting phase of the form. Please press 'Submit Form Details'. You may attach supporting evidence documents after submitting (e.g. an incident report produced by the college).

Attach Evidence Documents File URL File URL

Attach Evidence Documents