Rathdowne Incident and Breach Report

• Lot Number- Name

• Conducted on

  Date

• Prepared by

• Location
  Address

Incident and Breach Information

• Lot Number

• Resident Name

• Address

• Date Breach / Incident took place

  Date

• Location

Types of Incident or Breach

Category

• Accidental Abuse, language or conduct

  Yes

  No

  N/A

• Accident

  Yes

  No

  N/A

• Breach of Owners Corporation Rule

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Type of Breach

  Select More than 1 guest per household Child under 16 years of age left unattended in facility Child under 16 years of age in the Gym Swipe card belongs to another resident Non inducted resident using the facility without inducted resident Function Room Rules of Use Breach Smoking / Vaping within facility

  • More than 1 guest per household
  • Child under 16 years of age left unattended in facility
  • Child under 16 years of age in the Gym
  • Swipe card belongs to another resident
  • Non inducted resident using the facility without inducted resident
  • Function Room Rules of Use Breach
  • Smoking / Vaping within facility

• Offensive Abuse, languge or conduct

  Yes

  No

  N/A

• Dress Code

  Yes

  No

  N/A

• Complaint (Minor)

  Yes

  No

  N/A

• Refusal to Follow Instruction / Direction

  Yes

  No

  N/A

• Intentional Act

  Yes

  No

  N/A

• Disturbance

  Yes

  No

  N/A

• Theft - Local Police

  Yes

  No

  N/A

• Assault - Local Police

  Yes

  No

  N/A

• Any Other Matters Involving Police

  Yes

  No

  N/A

Statement of Accounts

• undefined

Consequence

• undefined

  Select 1st Offense- Warning 2nd Offense - 2 week Card Deactivation and reinduction 3rd Offense - 4 week Card Deactivation and reinduction 4th Offense - Referred to Quantum United Immediate Deactivation. Refer to Quantum United.

  • 1st Offense- Warning
  • 2nd Offense - 2 week Card Deactivation and reinduction
  • 3rd Offense - 4 week Card Deactivation and reinduction
  • 4th Offense - Referred to Quantum United
  • Immediate Deactivation. Refer to Quantum United.

Completion

• Add signature

  Sign

• Select date

  Date