City of Greater Bendigo

Details of the incident

Kind of incident*:
Incident type*:
Incident classification:
Description*:
Date and time of incident*: :
Date reported*:

Is this incident sensitive?

Is sensitive:
Please only tick this box if you are reporting
any sexual harassment policy breaches

Location incident occurred

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Reporting person details

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Family name*:

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Injured person details

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Injury details

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Injury a result of*:
Injured body part*:
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Medical treatment:
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Provider:
Treatment provided:
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Witnesses

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Notification

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