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Staff portal
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+1 555-555-5556
info@yourcompany.example.com
Follow us
Sign in
Contact Us
Subject
Address
Location
Incident Date
*
Participant
*
Approve Manager
*
Incident Type
*
Complaint - Noise
Juvenile - No ID
Patron Injured
Patreon Intoxicated
Patron - Asked to leave premise
Patron refused entry - offensive behaviour ( including violent, quarrelsome, disorderly, indecent behavior)
Complaint - other
Juvenile - forged/false counterfeit ID
Staff injured
Patron indecent behavior
Patron refused entry - Intoxicated
Patron repeatedly
Did the patron repeatedly attempt to gain entry?
Inappropriate behavior
Did the patron engage in offensive behavior after being refused entry?
hasController
Was the patron physically restrained/ removed / refused entry by crowd controller/s? (if so please state details of crowd controller who used physical contact) *
Crowd Controller
Detail
Action
Authority Notified
WA Police
Department of Racing, Gaming and Liquor
Emergency Services
Others
Another authority
Verifier
Who to be completed by manager or licensee if physical contact was used by crowd controller/s?
Testimony
Copy of this report provided to crowd control agent (if applicable)
Completer
Name of the manager/licensee completing this report
Image
Submit