Incident/Hazard Reporting Form

Use this form to lodge an incident report, misconduct, safety risks, injury or inappropriate behaviour.

If someone is in immediate physical danger, contact 000.

If on a Swinburne campus, also contact Swinburne Security at (03)9214 3333.

You can also report incidents via Safer Community safercommunity@swinburne.edu.au

Your Details

First name

Last name

Student or Staff No.

Phone

Relationship to FLEX

When and Where

Date of incident/hazard

Time

HoursMinutes

Location

Witness Name

Type of Event

Please upload any images or videos to assist with this.

Declaration

I confirm this is a true and accurate account to the best of my knowledge.

I understand that SSA may contact me regarding this matter. I consent to my personal details and the information being shared with relevant third parties, where necessary in accordance with local laws.

I understand that intentionally submitting false and or misleading information may result in disciplinary action taken including under Swinburne's Student Charter.