Queensland Government
Queensland Health
Queensland Government
Queensland Health

Incident Report Form

Ice Pipe and Bong Laws

Note: Fields marked with an asterisk must be completed. Please note if you have more than one incident to report, please submit a separate form for each incident.

All possible breaches reported will be investigated and if a breach is proven, on-the-spot fines or prosecutions will follow.
 
Location of Possible Breach
Location of possible breach:*
(eg. XYZ Retail Store)
Address:*
(eg. 47 Jones St, Brisbane)
Business phone:
(If applicable)
 
Ice Pipe and Bong Laws
Description of situation in which an ice pipe or bong was sold, supplied or displayed, or more than three hookahs were displayed:*
Date of possible breach:*  (DD.MM.YYYY)
Time of possible breach:
(If observed)
   
Your Contact Details
Please provide your details in the event a Queensland Health Officer may need to contact you to clarify any information you provide.
Name:
Phone:
E-mail:
Your Details:

Employer
Employee
Patron/general public
Other - Please specify:

   
 
   

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Last Updated: 13 March 2009
Last Reviewed: 13 March 2009



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