Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
Incident Details:
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Date/Time of INCIDENT
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Guards involved: (please list full names)
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Location:
- Sports Bar
- Sports Bar DOSA
- Gaming Lounge
- Gaming DOSA
- Restaurant Dining
- Restaurant Bar
- Restaurant Outdoor
- LAIR
- Other
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Please define:
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Action taken (multiple selections acceptable)
- Person Removed from Venue
- Person Refused Entry
- Refused service of Alcohol
- Offered water
- Left premises on own accord
- Other
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Please define:
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Behavior demonstrated/reason for action: (multiple selections acceptable)
- Unduly Intoxicated
- Physically Aggressive
- Verbally Abusive
- Disorderly Behaviour
- Other
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Please define:
Offending Person:
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Gender:
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Height:
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Hair:
- Short
- Long
- Bald
- Blonde
- Brown
- Other
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Clothing:
- Pants
- Skirt
- Dress
- Shirt (collar)
- T-Shirt
- Jacket
- Jersey
- Hat/Head wear
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Define Colour: (briefly)
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Is there CCTV footage available? If yes list camera number and times for review.
Action Taken:
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Was this person refused service?
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What time?
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By who?
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Was this person asked to leave?
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What time?
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Were they forcefully removed or touched as they were removed? (if yes note restraints/physical contact used)
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Why were restraints/contact used? (select multiple if applicable)
- To eliminate threat of violence
- Fearful for safety of patrons and staff
- Persons demonstrating violent behavior
- Person refused to leave premises
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Any injuries sustained during incident? (if yes, note extent and treatment)
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Brief explanation of events: (if necessary)
Conclusion:
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Select Liquor Act 1992 Legislation applicable to this event:
- Section 165 - Removal of persons from premises.
- Section 165A - Refusing entry to premises
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Has the on duty DM been briefed on the event?
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Has this been logged in the CC register? (add reference to this report)
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Time/Date Completed:
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Full Name and Signature: