Section 1: Your Details
Section 2: About the Behaviour
Section 3: Context of the Behaviour
Section 4: Impact on You
Section 5: Previous Actions Taken
Section 6: What You Need
Section 7: Confidentiality
(Optional—you may remain anonymous, but providing details may help us investigate more effectively)
Do you wish to remain anonymous?
YesNo
"Enter your full name."
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What type of behavior are you reporting?
—Please choose an option—Workplace Bullying (repeated, unreasonable behaviour creating a risk to health and safety)Other inappropriate workplace behaviour (please specify)
Who engaged in this behaviour?
—Please choose an option—Unknownknown
What is their relationship to you?
ManagerSupervisorCo-workerContractorClientOther
Has this behaviour occurred more than once?
← Previous
Where did the behaviour occur? WorkplaceRemoteOnlineClient siteOther
When did the behaviour occur?
Approximate time of the incident(s)
Were there any witnesses present? YesNo
How has this behaviour affected you personally? EmotionallyPhysicallyProfessionallyOther
Have you experienced changes in your work performance, health, or wellbeing because of this behaviour?
Have you reported this behaviour before?
Have you spoken directly to the person about their behaviour?
Have you sought support from HR, a manager, or external services (e.g., Fair Work, EAP, WHS regulator)?
What outcome would you like from this report?
InvestigationMediationNo further contactWorkplace adjustmentTrainingOther
Do you feel safe continuing to work in your current role/team while this matter is being addressed?
Do you want to be contacted for follow-up?
How would you prefer to be contacted?
—Please choose an option—EmailPhoneOther
Do you require immediate support (e.g., counselling, leave, workplace adjustment)?
⚖️ Australian Compliance Note:
This survey is framed in accordance with:
Fair Work Act 2009 – workplace bullying protections.
Work Health and Safety Act 2011 – employer duty to manage risks to health and safety.
Guidance from Safe Work Australia – recognising bullying as repeated unreasonable behaviour that creates a risk to health and safety.
