Incident Report Form Page 4

Have you reported the current incident to any of the following persons

Yes – Date report was made

OHS Rep

VIEU Rep

Principal

OHS Officer

Other – please provide further details

What happened as a result of your report?

The Principal is the bully

Nothing will happen to resolve the matter

Afraid the bullying will get worse

Fearful of losing my job

Wish to remain anonymous

Other – please provide further details

Has the incident been recorded in the Injury Book at you workplace?

Yes

Section 7

Impact on Health

Have you sought medical advice or assistance as a result of this or

previous incidents?

Yes

Have you lodged a workcover claim?

Yes – Date your claim was lodged

Has you claim been approved?

Yes

Describe how your health has been effected as a result of this or previous

incidents.

0 votes

Parent category: Business