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Incident Report Form
If you are currently signed to IMAE, please fill this form to report an incident. Please be aware that the Standard Excess on the Liability policy is $2,500.00 for Each & Every Claim.
Please provide your details.
IMAE Membership Number
Please provide details of the incident. If any of the space is insufficient, please use the File Upload section below.
Date of the incident
Time of the incident
Name/s of person/s involved in the incident
Please include contact details if available. This may include a patron, employee, or crowd controller if applicable.
Description of the incident
Please include contact details if available
Damage to inventory
Please provide details of any damages to stock/inventory and their respective monetary value if applicable.
Have the police attended to deal with the incident?
Police Incident Number
Please provide a police incident number or the name/rank of the attending officer/s if applicable. Please include the time the officer began dealing with the incident and their contact details.
Has an ambulance been involved or has a first aid kit been used?
Ambulance / first aid kit details
Please provide any relevant details of the ambulance involvement or the use of a first aid kit.
Was the incident recorded by an electronic surveillance device?
Please provide details of the surveillance device including ownership and how to obtain a copy of the surveillance.
Please provide files relevant to the incident if available.
Drop files here or
Accepted file types: jpg, jpeg, png, pdf, doc, docx.
Thank you for providing the necessary details. Please proceed by confirming the details below.
I have a have an active membership with IMAE
I have fully read and understand the IMAE Terms and Conditions
I confirm that the above information is true and correct