Sexual Assault/Sexual Harassment (SASH) Incident Form

Emergency Services:

NSW Rape Crisis

1800 424 017 - Available 24/7

Domestic & Family Violence Counselling Service

1800 222 387 - 8am-8pm AEST Monday – Friday

Sexual Assault Counselling Australia

1800 211 028 - 8am – 11pm AEST

1800 RESPECT - 1800 737 732

Person Reporting the incident

I/we prefer to remain anonymous

Important: If you prefer to remain anonymous, you are not required to provide your contact details. However, if you choose to remain anonymous then we may not be able to properly investigate and resolve the matter.

FIRST NAME

LAST NAME

CONTACT PHONE NUMBER

DATE OF THE INCIDENT

Location of the occurrence

Where did the incident occur?

TIME OF OCCURRENCE

DETAILS

Which of the following do you want to report (you can choose more than one option)?

Are you reporting for yourself or someone else? *

Myself

Someone else

I am a/ they are a:

If you are reporting on behalf of another person, do you have their permission

Yes

N/A- I am reporting my matter

The questions below relate to the perpetrator/s (person/s accused of wrongful behaviour). If there is more than one perpetrator, please provide additional information in the incident description box below.

The questions below relate to the perpetrator/s (person/s accused of wrongful behaviour). If there is more than one perpetrator, please provide additional information in the incident description box below.

Full name of the alleged perpetrator (if known)

Contact details of the alleged perpetrator( if known)

You think they are a:

What area of the college do they work or study in?

Type N/A or Unsure ( if relevant)

If applicable: What type of student are they?

Or, you may type out your response in MS Word and attach it below:

Suggestion: You may want to attach a copy of text messages or other kinds of evidence to support your complaint.

Drop your files here

Additional Information

Please provide details about the event(s), with dates, times and locations, if possible. The information you provide will be received by a SASH Task Force member and the information will be kept safe and secure. They might contact you (if you have provided contact details) to check on the safety and wellbeing of yourself and anyone else affected. If the SASH Task Force member believes there is a significant risk of harm to an individual or the community, they will refer the details to the Police. If the report is about someone who is underaged (under 18 years old), mandatory reporting applies and AC staff must inform the Police. AC will notify you immediately about this action and you can choose if you wish to participate in the police enquiry or not. More information can be found on the webpage and the policy for Sexual Assault and Sexual Harassment Policy and Procedures.

Send me a copy of my responses

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