Form A - STAGE-28

The quality of this research depends on your willing and honest participation so you are assured of confidentiality with your data stored on STAGE-28’s encrypted servers. Their security will deny access to any colleague, manager or organisation you may be associated with. Only your e-mail address will be retained at STAGE-28 to advise you of any mental health risk. We see no harm to you in completing this questionnaire or being informed of your risk-level. While your participation is welcome you can change your mind about taking part. If you wish to withdraw let us know and your data will be traced and deleted. Contact details, notification of concerns and research information appear on the final page where you submit your form.

Organisation *

Code/ID *

Two initials plus 4-digit birthday and month For example: for Joe Smith born 24/08/77 enter: ‘JS2408’

Email *

Age *

Gender Identity *

Male

Female

OtherOther

Current Status *

Married/De Facto

Single

Separated / Divorced

OtherOther

Rank *

Role *

Time in Role (Years / Months) *

If there is a troubling incident or situation you are, or have been involved in, what is it?

Please read the questions carefully and commit to your first answer clicking on the appropriate radio-button. Anything you would like to tell us, please type in the box below.