• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Incident and Breach Information

  • Details of Persons involved

  • Details of Witnesses<br>

Types of Incident or Breach

Category One (Verbal Warning)

  • Accidental Abuse

  • Accidental Language

  • Accidental Conduct

  • Dress Code (Minor)

  • Breach of Owners Corporation Rule (Minor)

  • Misconduct

  • Complaint (Minor)

  • Accident

Category Two (8,12 and 26 Week De-Activation)

  • Offensive Abuse

  • Offensive Lanuage

  • Offensive Conduct

  • Dress Code (Major)

  • Breach of Owners Corporation Rules (Major)

  • Refusal to Follow Instruction / Direction

  • Complaint (Major)

  • Intentional Act

  • Disturbance

Category Three (12 Month De-Activation)

  • Theft - Local Police

  • Assault - Local Police

  • Any Other Matters Involving Police

Statement of Accounts

  • A statement must be written narrative, presented in a logical sequence. Tell the story as it unfolded with as much details as possible.

  • Record of all events and conversations that took place. Include a list of any supporting material that may clear people of any wrong doing.

  • Add signature

  • Select date

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.