Psychosocial Hazard Reporting Form

This field is for validation purposes and should be left unchanged.

The Islamic College of Brisbane is committed to providing a psychologically safe and healthy workplace. This form enables staff to report psychosocial hazards or concerns that may impact their health, wellbeing, or ability to work safely. Reports will be assessed confidentially and, where appropriate, action will be taken to eliminate or minimise identified risks in accordance with the College's work health and safety obligations.

Please complete this form with as much detail as possible. All reports will be handled sensitively and in accordance with the College's privacy and WHS obligations.

Section 1: Staff Information

Please identify yourself so the College can assess and respond to the psychosocial hazard or risk being registered.

Staff Member's Full Name(Required)

Staff Member's ICB Work Email(Required)

Position Title(Required)

Department(Required)

Line Manager Full Name(Required)

Line Manager Email(Required)

Staff Category(Required)

Preferred Contact Method(Required)

Preferred Contact Number

Section 2: Risk Event or Concern

Record the hazard, repeated pattern, or incident that may be affecting psychological health and safety at work.

Date of Incident or Concern(Required)

Is this a one-off incident or an ongoing pattern?(Required)

Main Work Area Affected(Required)

Specific Location or Context

Psychosocial Hazard Category(Required)

Describe the Hazard, Incident, or Pattern(Required)

Please include factual details, frequency, relevant context, and immediate concerns. Avoid naming students unless necessary for follow-up.

Who or what is affected?

For example: yourself, team members, students, work area, supervision, or service delivery.

Section 3: Risk Assessment

Estimate the current level of risk so the College can prioritise review and controls.

Current Impact on Staff Wellbeing or Work(Required)

Likelihood of the Risk Continuing or Reoccurring(Required)

Overall Risk Rating(Required)

Observed Effects or Warning Signs

Existing Controls or Supports Already Tried

For example: behaviour plan, leadership support, debrief, supervision change, additional staff, parent contact, incident report.

What controls or support do you believe would reduce the risk?

Section 4: Immediate Safety, Support, and Escalation

Use this section to flag urgent matters and support needs. If there is immediate danger, follow the College emergency process immediately.

Is there an immediate safety concern?(Required)

Support Requested(Required)

Have you already informed your line manager?(Required)

May HR or Leadership contact you about this register entry?(Required)

Any confidentiality, timing, or contact considerations?

Supporting Documents or Evidence Upload

Drop files here or

Accepted file types: pdf, doc, docx, jpg, jpeg, png, Max. file size: 512 MB, Max. files: 5.

Optional. Upload relevant documents, screenshots, notes, incident references, or supporting material if appropriate.

Section 5: Declaration

Please confirm the information is submitted in good faith for workplace health and safety review.

Staff Declaration(Required)

I confirm this register entry is made in good faith and is accurate to the best of my knowledge.

I understand this information will be used by authorised ICB personnel to assess and respond to psychosocial hazards and workplace health and safety risks.

I understand this form is not an emergency response pathway and urgent safety matters must be escalated through the appropriate College process immediately.

Staff Member's Signature(Required)

Date Submitted(Required)