Form / ReportOne Dream2025-01-09T16:35:09+10:00 Forms and ReportFeedback & Complaint FormIncident & Injury FormFeedback & Complaint Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Feedback, Compliments and Complaints Refort Form Compliments, complaints and other feedback provide us with valuable information about your satisfaction with our services. Feedback is taken seriously by One Dream Community and is seen as an opportunity for imrpovement. Please let us know what you think. NameContact Detail:This is a: ComplimentComplaintFeedbackI am a:ParticipantFamily MemberParticipant RepresentativeStaff MemberStaff Member on behalf of participantOther (Please specify):Please tell us about your experience at One Dream CommunityPlease share your ideas or suggestions with usWould you like us to follow up with you on your feedback? YesNoFeedback, compliments, and complaints can be lodged: Directly with a staff member, either verbally or by providing a completed Feedback, Compliments and Complaints Form. By email to: info@onedream.org.au By Phone on 1800 841 777 Your complaint will be formally acknowledged within two working days. We aim to respond to all complaints and grievances as quickly as possible, within 14 days from acknowledgement. All feedback and complaints will be used by One Dream Community to continuously improve our service delivery. Thank you for taking the time to provide feedback about our service. Submit Incident & Injury Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Who Involed:WorkerClientClient's familyOther:Full Name: *Date of Birth: *Did you notify other parties?(e.g. family/representative/office)?YesNoGenderMaleFemaleDate and time of incident: *DateTimePhone: Who did you inform? Witness(1) name (if applicable):Phone:Address:Witness(2) name (if applicable): Phone: Address: Type of IncidentBurnMedical ErrorDeathHitting by Moving ObjectMedical Concern (Illness, Injury, Infectious Condition)Mental StressUnseasonal Use of ForceRaised Conflict of InterestServices and Support for Daily LivingMotor Vehicle AccidentProperty, Equipment and Furniture Damage (Owned by the Consumer)ElectricityFallTrip, Slip, Loss of balance, Collapse :Details incident (Fall)WoundSkin Tear, Pressure Injury, Bruise:Details incident (Wound)Medical ConcernIllness, Injury, Infectious Condition:Details incident (Medical Concern)Medical Event Hospital TransferDetails incident (Medical Event)Using Unsafe EquipmentDevice, Furniture and Fitting etc.Details incident Deteriorationor Change of a Consumer's Mental Health, Cognitive or Physical Function:Details incident Behavior of ConcernPhysical, Verbal, Absconding)Details incident ViolenceAbuse, Neglect, Exploitation, Discrimination:Details incident Inappropriate Physical or Chemical RestraintsDetails incident StealingCoercion by Staff MemberDetails incident OtherIncident Details:Description of the IncidentActions takenMedically treated? *YesNoIf yes, First aidMedical centreHospital (Admission)Head Injury Details( Part or the head injuries)Temporal regionParietal regionZygomatic regionOccipital regionAuricular regionMastoid regionParatideomasseteric regionBuccal regionMental regionOral regionNasal regionInfaorbital regionOrbital regionFrontal region Body Injury Details( Part or the body injuries) Front UpperArmpitBrachialFront elbowForearmWristThumbPalmFingersChestBreastAbdomenNavelHipBody Injury Details( Part or the body injuries) LowerArmpitBrachialFront elbowForearmWristThumbPalmFingersChestBreastAbdomenNavelHip Body Injury Details( Part or the body injuries) BackShoulderBackLoinSacrumBack elbowButtockThighBack of kneeCalfUpper limbLower limbReport completed by: *Date / Time *Submit
