Report Incident, Complaint or Malpractice

1. Case Details

Case Reference Number

Case Type *

Please select case type.

Date Reported *

Please select date reported.

Time Reported

Reported By *

Please enter reporter name.

Role of Reporter

Test Centre / Location

Related Test / Service

2. Person Involved

Candidate / Staff / Centre Name

Candidate ID / Staff ID / Centre Code

Role

Contact Details

3. Issue Summary

Short Title of Case *

Please enter short title.

Date of Incident / Issue

Time of Incident / Issue

Description of Issue *

Please enter description of issue.

4. Case Type Details

If Incident

Type of Incident

Did the test continue?

Immediate action taken

If Complaint

Complaint made by

Response required?

Complaint summary

If Malpractice

Type of suspected malpractice

Was any rule breached?

Was the result or certificate affected?

5. Evidence

Evidence Available

Documents / files attached

You may attach one or more files.

Additional notes

6. Immediate Action Taken

Action taken at the time

Was anyone informed?

If yes, who was informed?

7. Review Notes

Reviewed By

Review Date

Review Notes

8. Outcome

Outcome

Outcome Details

9. Closure

Final Decision By

Position

Decision Date

Case Status

Closure Date

10. Internal Use Only

Linked Review of Results Case

Linked Certificate Record

Linked Verification Record

Notes