Title Page
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Event Type
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Event Title - Short description of event
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Date and time when first noticed or occurred
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Where did the incident occur?
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Guardian centre/office name
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Please identify the non-Guardian location
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Where at the centre or support office location did the incident occur? - Include the room/playground/area name (e.g. block area in the Echidna room)
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Indoors or Outdoors?
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Describe, in detail, what happened
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(Select all that apply) Did the incident involve:
- Injury/illness
- Suspected child harm/neglect
- Trauma or suspected trauma
- Alleged physical/sexual abuse
- Child wellbeing (emotional)
- Emergency event/drill
- Child missing or unaccounted for
- Child locked in/out
- Death of a child/adult
- Bullying/harassment
- Property/equipment damage
- Cyber security/data privacy
- Weather event
- Chemical spill
- Security concern
- Theft
- Vehicle/transport
- Services interruption (Power/water)
- Flooding inside/outside
- Power outage
- Food safety incident
- Other
- Child sexualised behaviour
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Immediate Actions taken
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Was emergency services involved?
- Ambulance
- Fire Brigade
- Police
- No or N/A
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Photos/Attachments -Attach photo(s) of site of incident/hazard/equipment or upload any documents such as complaints received
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Who was involved in the incident? You will need to complete a personal details and injury/illness form for each child/adult
- Child
- Employee
- Contractor
- Visitor
- N/A
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Person(s) responsible for parent/guardian sign off (required for child incidents)
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Name of Responsible Person(s) on duty
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Signature of the person completing this form
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Event Title - Short description of event
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Date and time when first noticed or occurred
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Where did the hazard occur?
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Please identify the non-Guardian location
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Guardian centre/office name
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Where at the centre or support office location was the hazard found? - Include the room/playground/area name (e.g. block area in the Echidna room)
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Indoors or Outdoors?
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Describe, in detail, what happened
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For the question below:
Low: We can fix this issue within Centre by reviewing and applying controls
Medium: We need to escalate to notify Ops manager and thoroughly investigate due to potential risk
High: We need to focus on this – lets alert the GM for awareness and guidance . Any activity planned scoring high or above should be suspended until controls in place
Extreme: An extreme event may be extraordinary weather causing damage to property and facilities threatening to partial or full close down of Centre, major event or any outbreak of communicable diseases which require us to report to the Dept and seek further controls to risk. -
Potential
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Does the event involve facilities?
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Is there an imminent risk to children and/or adults?
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Immediate Actions taken
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Is the Hazard resolved?
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Photos/Attachments
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Name of the person completing this form
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Event Title - Short description of event
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Date and time when first noticed or occurred
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Where did the incident occur?
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Guardian centre/office name
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Please identify the non-Guardian location
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Where at the centre or support office location did the incident occur? - Include the room/playground/area name (e.g. block area in the Echidna room)
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Indoors or Outdoors?
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Describe, in detail, what happened
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Does the person involved want to leave their details?
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Name of the person
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Contact number
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Immediate Actions taken
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Photos/Attachments
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Name of Responsible Person(s) on duty
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Name of the person completing this form
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Event Title - Short description of event
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Date and time when first noticed or occurred
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How was the complaint received?
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Please outline how the complaint was received
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Where did the incident occur?
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Guardian centre/office name
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Please identify the non-Guardian location
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Reason for the complaint/grievance
- Animal
- Centre cleanliness/hygiene
- Child protection allegation adult to child
- Child protection allegation child to child
- Furniture or equipment resulting in harm
- Inappropriate discipline - team member to child
- Incident related to care routines
- Ingestion/inhalation/insertion of a resource
- Mismanagement of medical conditions
- Non-serious incidents
- Physical interaction between children
- Serious incident/injury - broken bone, head injury, surgery
- Supervision
- Communication with families
- Inadequate educational program
- Significant dissatisfaction (multiple areas)
- Insufficient staffing/ratios
- Bullying/harassment
- Leadership team
- Centre design
- Fees
- Other
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Details of other compaint
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Describe, in detail, what happened
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Did the incident involve:
- Injury/illness
- Suspected child harm/neglect
- Trauma or suspected trauma
- Alleged physical/sexual abuse
- Child wellbeing (emotional)
- Emergency event/drill
- Child missing or unaccounted for
- Child locked in/out
- Death of a child/adult
- Bullying/harassment
- Property/equipment damage
- Cyber security/data privacy
- Weather event
- Chemical spill
- Security concern
- Theft
- Vehicle/transport
- Services interruption (Power/water)
- Flooding inside/outside
- Power outage
- Food safety incident
- Other
- Child sexualised behaviour
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Other:
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Name of the person making the complaint/grievance
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Contact number
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Email
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Home Address
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Is the complaint/grievance in relation to
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Child's Name
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Child's Date of Birth
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Child's Gender
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Please specify
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Please specify
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Immediate Actions taken
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Photos/Attachments
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Name of the person completing this form
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Who needs to be notified of this complaint/grievance? If confidential, ONLY select confidential
- Centre
- Portfolio Manager
- General Manager
- People & Culture
- Compliance
- Health and Safety
- Confidential - to the Whistleblower Protection Officer
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Event Title - Short description of event
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Illness Type
- Positive COVID notification
- Household contact case
- Gastro symptoms
- Gastro confirmed by pathology
- Hand, Foot and Mouth
- Chicken Pox
- RSV
- Measles
- Mumps
- Rubella
- Influenza
- Slapped Cheek
- Other - outline in description
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Centre
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State
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Person Completing this form
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Centre contact mobile number
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Positive case : Full Name
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Positive Case : DOB
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Positive case : Relationship to Guardian
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Positive case : Contact number
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Vaccination status of positive person
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How were you notified and by whom?
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Date of test taken
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Type of test taken
- Rapid Antigen Test
- Rapid Antigen Test - Guardian Supplied
- PCR Test
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What was the last date the person attended the centre?
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Why was this person tested?
- Household contact or similar
- Workplace contact
- High risk contact
- Social contact
- Has developed symptoms
- Person is concerned
- Attended exposure site
- Other
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Other Reason
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Date test result received
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Test result
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Was the person symptomatic or asymptomatic?
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What date did the person start showing symptoms?
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Please list individual days, times and rooms person attended the centre for the 7 days prior to testing
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Was the person wearing a mask?
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Is the case related to another current Guardian closure/isolation event?
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Please list the centre
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Comments/notes/explanations
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Household Contact case: Full Name
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Household Contact case: DOB
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Household Contact case: Relationship to Guardian
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Vaccination status of positive person
- Unvaccinated
- Single vaccination (1 dose)
- Double vaccination (2 dose)
- Booster (3 dose)
- Booster (4 dose)
- Medical exemption
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Will you be attending the centre for work or care in the 7 days following the positive test result of the household member?
