Vehicle Incident Report Form – Safety & Reporting

Use this form to record vehicle incidents and near misses, as well as request vehicle maintenance. If necessary, you can contact the Ground Transport Coordinator to submit further information via [email protected]

All fields are required, so please indicate in the field if you are unsure of any details.

You save this form and send yourself a link to continue it later.

"*" indicates required fields

Report Type*

Report a NEAR MISS, request vehicle MAINTENANCE, or report an ACCIDENT involving other people, vehicles or property.

Near miss

Maintenance

Accident

Driver of Festival Vehicle

The driver and reporter of the incident, who was driving a Festival-owned or hired vehicle.

Name of Festival Driver*

The Festival driver’s name, as shown on their Driver’s License.

First Last

Festival Driver's Phone Number*

Festival Driver's Email*

Incident Time and Location

Incident Date*

The date the incident occurred or was identified.

Incident Time*

The time the incident occurred or the hazard was identified, in 24-hour format.

Location of Incident*

Street Address Suburb State Postcode Country

Person Notified*

The supervisor, manager or Ground Transport personnel that was notified following the incident.

Notification Method*

How you notified the supervisor, manager or Ground Transport personnel of the incident.

Reporter Statement*

Description of accident, including the apparent cause.

Details

Festival Vehicle Details*

Make, model and license plate number of Festival vehicle.

Near Miss*

Description and details of the near miss.

Maintenance*

Describe the maintenance or repair required to the Festival vehicle.

Other Parties*

Indicate if the incident involved other vehicles, property or people (i.e. pedestrians and cyclists).

Other Vehicles

Other Property

Other People

The Other People involved in the incident (i.e. pedestrians and cyclists)

Name of Other Person*

Name of the pedestrian or cyclist.

First Last

Other Person's Phone Number*

Other Person's Address*

Street Address Suburb State Postcode Country

How many Other Vehicles were involved*

3 +

Driver of Other Vehicle

The Other Vehicle involved in the incident.

Name of Other Driver*

Name of the Driver of the Other Vehicle.

First Last

Other Driver's Phone Number*

Other Driver's Address*

Street Address Suburb State Postcode Country

Other Driver's Licence No.*

Licence number of the Driver of the Other Vehicle.

Other Driver's Licence Expiry*

Other DL State of Issue*

Other Driver's Insurance*

Name of Other Driver’s insurance company.

Other Vehicle Details*

Make, model and license plate number of the Other Vehicle.

Driver of Other Vehicle #2

The Other Vehicle #2 involved in the incident.

Name of Other Driver #2*

Name of the Driver of the Other Vehicle #2.

First Last

Other Driver #2's Phone Number*

Other Driver #2's Address*

Street Address Suburb State Postcode Country

Other Driver #2's Licence No.*

Licence number of the Driver of the Other Vehicle #2.

Other Driver #2's Licence Expiry*

Other #2 DL State of Issue*

Other Driver #2's Insurance*

Name of Other Driver #2’s insurance company.

Other Vehicle #2 Details*

Make, model and license plate number of the Other Vehicle #2.

Driver of Other Vehicle #3

The Other Vehicle #3 involved in the incident.

Name of Other Driver #3*

Name of the Driver of the Other Vehicle #3.

First Last

Other Driver #3's Phone Number*

Other Driver #3's Address*

Street Address Suburb State Postcode Country

Other Driver #3's Licence No.*

Licence number of the Driver of the Other Vehicle #3.

Other Driver #3's Licence Expiry*

Other #3 DL State of Issue*

Other Driver #3's Insurance*

Name of Other Driver #2’s insurance company.

Other Vehicle #3 Details*

Make, model and license plate number of the Other Vehicle #2.

Property Damage

Owner's Name*

Name of owner of the property involved in the incident.

Owner's Address*

Address of the property involved in the incident.

Street Address Suburb State Postcode Country

Property Owner's Phone Number*

Injuries / Deaths

Injuries or Deaths*

Were any drivers, pedestrians or other people injured/killed in the incident?

Yes, one person

Yes, multiple people

No injuries or deaths

Damage & Injuries*

Describe injuries/damage to people, vehicles or property involved in the incident.

Police

Police*

Did police attend the incident?

Yes

Is police action pending?*

Yes

Legal

Police Name*

Name of investigating officer, their badge no. and police station.

Violation – Festival Driver*

Traffic violations charged to the Festival Driver as a result of the incident.

Violation – Other Driver*

Traffic violations charged to the Other Driver as a result of the incident.

Witnesses

Witnesses*

How many witnesses are you recording the details of?

1 witness

2 witnesses

No witness

Witness #1

Name of Witness #1*

First Last

Phone Number of Witness #1*

Address of Witness #1*

Street Address Suburb State Postcode Country

Witness #2

Name of Witness #2*

First Last

Phone Number of Witness #2*

Address of Witness #2*

Street Address Suburb State Postcode Country

Vehicle Images

Upload pictures of damage to vehicles or property, required maintenance, or other relevant documents.

Max. file size: 10 MB.