VIS Public Incident Report

Incident Type

Record who was affected, what happened, and any immediate care or escalation that took place.

Name of injured/ill person

Injured person date of birth

Injured/ill person contact number if known

Injured/ill person’s relationship to VIS

Nature of injury/illness

Cause of injury/illness

Please describe what occurred, with as much factual detail as possible

Details of witnesses or others involved (name, contact info)

Was first aid provided?

Yes No

Was 000 called?

Yes No

Was injured/ill person referred to further medical consultation?

Yes No

Incident Type

Describe the event clearly and include any first aid, emergency response, or follow-up details.

Please describe what occurred

Details/witnesses of others involved

Was first aid provided?

Yes No

Was 000 called?

Yes No

Was injured/ill person referred to further medical consultation?

Yes No

Incident Type

Explain what was damaged and whether the facility manager has already been notified.

Describe issue/damage

Has facility manager been notified?

Yes No

Supporting Files

Attach photos or documents only if they help clarify what happened.

Please upload any supporting documents

Choose files from your device Photos, PDFs, and Word documents are supported. You can leave this blank if you do not have files to attach.

Up to 5 files, 10 MB each. Accepted: JPG, PNG, PDF, DOC, DOCX.