Issue Entry FormUse this form to lodge an incident report, complaint, warning, or improvement suggestionPage 1 of 3Type*IncidentComplaintWarningImprovementSelect the most appropriate title that describes the main category of the issue.Summary*A short summary of the issue in less than 80 charactersActivity*Please selectAccommodationConsultingExcursionsGeneralNDISPartiesRentalsRidingToursWhich area (if any) of the business does this issue best relate to?LocationWhere did this incident occur?DateDate of incident resulting in accident or complaintTimeTime of incident leading to accident or complaint if relevantReportableMust be reported?Tick if you believe that this incident needs to be reported to an authority (Police/NDIS Commissioner/WHS etc.)Description*Describe details of the issue (note that contact details of people involved are collected later and do not need to be included here)NextYour role*Please selectCustomerManagerOrganisationOwnerStaffSupplierWitnessPlease select the option that best describes your role in relation to this incident (only select witness if none of the other options apply)Contact DetailsPlease note that for complaints it is not mandatory to complete the following fields. If you do NOT supply a valid email address you will not be able to receive notifications or access the issue later.NameFirst name and surnameEmail addressBest email contact to use for contact and followupPhonePhone contact number - mobile is preferableOrganisationThe organisation you represent - please only specify if relevant to the issueImpactImpact TypePlease selectFinancial LossNoneOffencePhysical InjuryPoor OutcomeProperty DamagePsych TraumaSexual AbuseThreat of HarmVerbal AbuseSelect option which best describes the impact of the incident. For incidents, this form makes provision to add THREE different people/impact reports. Leave blank for complaint if not relevant.Impact DescriptionProvide details of the impact selectedBackNextThis page provides the opportunity to add additional impact statements for people involved in an incident. If the issue is not an incident, then please click on Send to submit the issue as is. NOTE: Additional data and files can be attached to this issue using the Issues App on the TG Team Portal under TG Team menu. You will need to register an account on the website in order to access this menu. Second person?YesCheck if you wish to add the impact description for a second person.Contact DetailsRole*Please selectCustomerManagerOrganisationOwnerStaffSupplierWitnessPlease select the option that best describes the role of the second person in relation to this incident (only select witness if none of the other options apply)NameFirst name and surnameEmail addressBest email contact to use for contact and followupPhonePhone contact number - mobile is preferableOrganisationThe organisation you represent - please only specify if relevant to the issueImpactImpact TypePlease selectFinancial LossNoneOffencePhysical InjuryPoor OutcomeProperty DamagePsych TraumaSexual AbuseThreat of HarmVerbal AbuseSelect option which best describes the impact of the incident. This form makes provision to add THREE different people/impact reports.Impact DescriptionProvide details of the impact selectedThird person?YesContact DetailsRole*Please selectCustomerManagerOrganisationOwnerStaffSupplierWitnessPlease select the option that best describes the role of the second person in relation to this incident (only select witness if none of the other options apply)NameFirst name and surnameEmail addressBest email contact to use for contact and followupPhonePhone contact number - mobile is preferableOrganisationThe organisation you represent - please only specify if relevant to the issueImpactImpact TypePlease selectFinancial LossNoneOffencePhysical InjuryPoor OutcomeProperty DamagePsych TraumaSexual AbuseThreat of HarmVerbal AbuseSelect option which best describes the impact of the incident. This form makes provision to add THREE different people/impact reports.Impact DescriptionProvide details of the impact selectedCommentsPlease note anything else that you think is relevant to the issue which you have not mentioned in any other question.BackSendThis field should be left blank
