By entering personal information and details of incidents in this form, you consent to the information being collected and used to support the victim/survivor (which may include you and/or others) and assist ACU to take appropriate action in response to the report.
You are not required to include your name in the report, allowing you to remain anonymous, however, it may limit the university’s ability to investigate. Accordingly, you are encouraged to include your name and contact details. Having this information will assist ACU to investigate the matter and, where appropriate, take action; it will also enable the university to contact you and connect you with appropriate support services.
You can contact ACU at any time to withdraw your consent, or to access or correct the personal information we hold about you. If you are located in the European economic area and the General Data Protection Regulation applies, you may also contact ACU regarding your right to portability, erasure, restriction or objection to processing.
Please agree to the above privacy statement to submit the form.
Details of incident
Please describe what happened.
You can provide as much or as little detail as you wish. If you feel uncomfortable providing all the information here, that's okay - we can contact you directly to have a confidential discussion.
This may include the following:
- what happened?
- who was involved? (provide names of any person you're concerned about or who witnessed the incident - or provide a description if you don't know their names)
- were ACU Security or emergency services contacted?
If there is not enough space, please feel free to write in a Word document and upload it at Q18.
If completing this section causes you distress, you can:
- Contact Safeguarding and Student Safety team
- Contact ACU Counselling Service (ACU students only) to make an appointment
- Contact ACU 24 Hour Mental Health Support Line Call 1300 638 485 or text 0488 884 191
- Call 1800 RESPECT (1800 737 732) or Lifeline Australia on 13 11 14 for immediate 24-hour telephone counselling
- Contact the Employee Assistance Program, AccessEAP (ACU staff only) on 1800 818 728.
- Contact QLife - LGBTIQ+ peer support and referral service 1800 184 527 or webchat qlife.org.au
Answering this question is optional.
Providing any information helps the Safeguarding and Student Safety team better understand the ways in which we can support you and also assists with our understanding of what happened to you. This section can also be addressed over the phone or email should you feel more comfortable.
A police investigation may take precedence over an ACU investigation and ACU will cooperate closely with the police to ensure the safety of the university community.
Details of Alleged Offender(s)
These questions provide an opportunity to include details of the person(s) believed to be responsible for what happened to you.
Please indicate below if you feel there is a risk of harm by disclosing this information.
Should you disclose that an ACU staff member is believed to have been responsible, and enough information is provided that this staff member could be reasonably identified, ACU is required to provide the report to the Chief People Officer to ensure the protection of the university community.
Please note, this is only an indication of your desired outcome and the university will give due consideration to it, but ACU is not obligated to carry out the outcome if it is not able to. Any action imposed by the university will be in accordance with the Students Complaints Policy and Procedure and only applicable to formal reports, not to a disclosure.