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Incident and Feedback Report Form

If you or anyone you know is in immediate danger, please call 000 for assistance.
For immediate personal support, please call Lifeline: 13 11 14.

Thank you for taking the time to reach out. Your decision to share your experience—whether it’s a WHS Incident/Hazard, a Safer Churches Concern, or General Feedback—is vital in helping us maintain a safe, respectful, and supportive environment for everyone within our church community. Please know that the details you provide will be handled with the utmost confidentiality and care, respecting privacy at all times.

Every submission is taken seriously. Our dedicated team will review your report or feedback thoroughly. Depending on the nature of your submission, it will be directed to the appropriate team or person (such as the Safer Churches Officer, WHS Officer, relevant Department Leader, Campus Lead Pastor, Executive Team, or the GC Board) to ensure it is investigated and addressed in line with our church’s policies and values. We are committed to resolving concerns promptly, and we also love sharing positive feedback with our teams as we nurture a culture of care and celebration.

By submitting this form, you are playing an important role in upholding the safety, integrity, and well-being of our community. We truly appreciate your trust and cooperation.

Please Note: Generocity Church will fulfil all reporting obligations according to National and State legislation, including mandatory reports to the Department of Communities and Justice, police, or other government statutory authorities. It is an offence to provide false or misleading information.

Understanding Report Categories

To help us direct your report effectively, please select the category that best describes your submission:

  • WHS Incident / Hazard: Choose this for matters related to physical safety incidents, injuries, accidents, near-misses, or potential hazards involving Generocity Church activities, property, equipment, or environment. (Examples: Slips/trips/falls, equipment malfunction risk, unsafe conditions, activity injury).

  • Safer Churches Concern: Choose this if your report concerns the safety, welfare, or protection of a child, young person, or vulnerable adult. This includes concerns about behaviour (by any person), neglect, potential breaches of our Child Protection Policy or Code of Conduct. Remember to call 000 first if anyone is in immediate danger.

  • General Feedback: Choose this for providing compliments, suggestions for improvement, or raising concerns/complaints about church services, processes, ministries, non-safety related conduct, or other general church matters.


Section 1: Report Type Selection

1.1 What type of report are you making? (Please circle ONE and complete the sections indicated)

  • (A) WHS Incident / Hazard -> Complete Sections 2, 3, 6, 7, 8

  • (B) Safer Churches Concern -> Complete Sections 2, 4, 6, 7, 8

  • (C) General Feedback - > Complete Sections 2, 5, 6, 7, 8

Section 2: General Details (Complete for ALL Report Types)

2.1 Date and Time of Incident / Observation / Feedback Relevance:
Date: ___________________________
Time: ___________________________ (Approximate if needed)

2.2 Location:
(Specific campus, area, ministry, online platform, etc.) ___________________________________________________________________________________________________

2.3 Names & Roles of Individuals Involved / Witnesses:
(List all known people - victim, witness, subject of report, staff, volunteer, member, etc.  
Name: __________________________________________________ Role: ___________________________ 
Name: __________________________________________________ Role: ___________________________ 
Name: __________________________________________________ Role: ___________________________

(use space below to include any other relevant individuals or witnesses)

Section 3: WHS Incident / Hazard Details (Only complete if you selected A in Section 1)

3.1 Detailed Description: (Describe what happened or the hazard observed. Focus on facts: sequence, conditions, actions, objects involved.)

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3.2 Was there any injury involved? (Circle) Yes / No
If Yes, describe injury & medical assistance provided: _____________________________________________

3.3 Was there any Property Damage? (Circle) Yes / No
If Yes, describe damage & if reported to maintenance/security: _____________________________________________

3.4 Were safety protocols followed? (Circle) Yes / No / Unsure / Not Applicable
If No, please explain why not: _____________________________________________

3.5 For Hazards: Is the hazard still present? (Circle) Yes / No / Unsure

3.6 For Hazards: Mitigation Measures Taken?
(Describe any steps taken already) ______________________________________________________________
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Section 4: Safer Churches Concern Details (Only complete if you selected B in Section 1)

Reminder: If anyone is in immediate danger, call 000 first.

4.1 Name(s) of Child(ren)/Young Person(s)/Vulnerable Adult(s) of Concern:
(If known) ___________________________________________________________________________________________________
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4.2 Name(s) & Role(s) of Person(s) whose behaviour caused concern:
(If applicable/known) _____________________________________________

4.3 Detailed Description:
(Describe the concern, behaviour, disclosure. Be factual: what did you see/hear? Who said what? When? Where? Who else was present?)

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4.4 Is the child/young person/vulnerable adult safe now? (Circle) Yes / No / Unsure *  
If No/Unsure, describe current safety status/concerns: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

4.5 Reported to Police or Child Protection Services? (Circle) Yes / No *  
If Yes, provide details (Agency, date, ref#): ______________________________________________________
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4.6 Immediate Actions Taken?
(Describe any steps you/others took regarding this concern) ___________________________________________________________________________________________________
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4.7 Previous Concerns?
(Are you aware of prior related concerns involving these individuals?) ___________________________________________________________________________________________________
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Section 5: General Feedback Details (Only complete if you selected C in Section 1)

5.1 Nature of Feedback: (Circle ONE)

  • Compliment / Positive Feedback

  • Suggestion for Improvement

  • Concern / Complaint

  • Other (Specify: _____________________)

5.2 Detailed Description: (Provide details about your feedback/compliment/suggestion/concern)

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5.3 Desired Outcome (Optional):
(What would you ideally like to see happen?)
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5.4 Who should review this feedback? (Please circle ONE)

  • Campus Lead Pastor (This is the standard process for local feedback)  

  • Executive Leadership (Senior Pastor, Executive Pastor, Business Manager, Board Representative) (Select this if you prefer the Campus Lead Pastor not be the primary reviewer)

Section 6: Follow-Up & Notification (Complete for ALL Report Types)

6.1 Immediate Follow-Up Actions Taken:
(Describe any other steps taken immediately after the incident/observation, if not covered in Sections 3, 4 or 5)
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6.2 Who else was notified about this incident/concern/feedback? (If anyone) ___________________________________________________________________________________________________
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Section 7: Attachments (Complete for ALL Report Types)

7.1 Supporting Documents/Images:
(Please list or describe any items you are attaching separately) _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Section 8: Reporter Information (Your Details)

Providing your details is helpful for follow-up but optional if you wish to remain anonymous (unless legally required for mandatory reporting, e.g., for Safer Churches concerns reported by staff/volunteers). Information is kept confidential as per our privacy policy and legal obligations.

8.1 Your Full Name:
___________________________________________________________________________________________________

8.2 Your Role/Position:
(e.g., Member, Volunteer, Staff, Visitor)
___________________________________________________________________________________________________

8.3 Contact Information:
Email: ___________________________
Phone: ___________________________

8.4 May we contact you about this report? (Circle) Yes / No

8.5 If Yes, preferred method? (Circle) Email / Phone

Section 9: Submission Instructions

Please submit the completed form via one of these methods:

What Happens Next: Your report will be reviewed by the appropriate team members (Safer Churches Officer, WHS Officer, Executive/Pastoral staff). You may be contacted for further details if you provided contact information and permission, or if required by law. Appropriate investigation, resolution, and follow-up actions will be taken in line with church policy and legal requirements.

Thank you for taking the time to submit an incident report. Your input is crucial in helping us maintain a safe and supportive environment at Generocity Church.

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