Eviction Report

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

Incident Details:

• Date/Time of INCIDENT

  Date

• Guards involved: (please list full names)

• Location:

  Select Sports Bar Sports Bar DOSA Gaming Lounge Gaming DOSA Restaurant Dining Restaurant Bar Restaurant Outdoor LAIR Other

  • Sports Bar
  • Sports Bar DOSA
  • Gaming Lounge
  • Gaming DOSA
  • Restaurant Dining
  • Restaurant Bar
  • Restaurant Outdoor
  • LAIR
  • Other

• Please define:

• Action taken (multiple selections acceptable)

  Select Person Removed from Venue Person Refused Entry Refused service of Alcohol Offered water Left premises on own accord Other

  • Person Removed from Venue
  • Person Refused Entry
  • Refused service of Alcohol
  • Offered water
  • Left premises on own accord
  • Other

• Please define:

• Behavior demonstrated/reason for action: (multiple selections acceptable)

  Select Unduly Intoxicated Physically Aggressive Verbally Abusive Disorderly Behaviour Other

  • Unduly Intoxicated
  • Physically Aggressive
  • Verbally Abusive
  • Disorderly Behaviour
  • Other

• Please define:

Offending Person:

• Gender:

  Male

  Female

• Height:

  Short 120-150cm

  Average 150-175cm

  Tall 175-200cm

• Hair:

  Select Short Long Bald Blonde Brown Other

  • Short
  • Long
  • Bald
  • Blonde
  • Brown
  • Other

• Clothing:

  Select Pants Skirt Dress Shirt (collar) T-Shirt Jacket Jersey Hat/Head wear

  • Pants
  • Skirt
  • Dress
  • Shirt (collar)
  • T-Shirt
  • Jacket
  • Jersey
  • Hat/Head wear

• Define Colour: (briefly)

• Is there CCTV footage available? If yes list camera number and times for review.

  No

  Yes

Action Taken:

• Was this person refused service?

  Yes

  No

• What time?

  Date

• By who?

• Was this person asked to leave?

  Yes

  No

• What time?

  Date

• Were they forcefully removed or touched as they were removed? (if yes note restraints/physical contact used)

  No

  Yes

• Why were restraints/contact used? (select multiple if applicable)

  Select To eliminate threat of violence Fearful for safety of patrons and staff Persons demonstrating violent behavior Person refused to leave premises

  • To eliminate threat of violence
  • Fearful for safety of patrons and staff
  • Persons demonstrating violent behavior
  • Person refused to leave premises

• Any injuries sustained during incident? (if yes, note extent and treatment)

  No

  Yes

• Brief explanation of events: (if necessary)

Conclusion:

• Select Liquor Act 1992 Legislation applicable to this event:

  Select Section 165 - Removal of persons from premises. Section 165A - Refusing entry to premises

  • Section 165 - Removal of persons from premises.
  • Section 165A - Refusing entry to premises

• Has the on duty DM been briefed on the event?

• Has this been logged in the CC register? (add reference to this report)

• Time/Date Completed:

  Date

• Full Name and Signature:

  Sign