Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

Incident Details:

  • Date/Time of INCIDENT

  • Guards involved: (please list full names)

  • Location:

  • Please define:

  • Action taken (multiple selections acceptable)

  • Please define:

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

  • Please define:

Offending Person:

  • Gender:

  • Height:

  • Hair:

  • Clothing:

  • Define Colour: (briefly)

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

Action Taken:

  • Was this person refused service?

  • What time?

  • By who?

  • Was this person asked to leave?

  • What time?

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

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

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

  • Brief explanation of events: (if necessary)

Conclusion:

  • Select Liquor Act 1992 Legislation applicable to this event:

  • 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:

  • Full Name and Signature:

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