Vehicle Incident – Safety & Reporting

Use this form to record vehicle incidents, if necessary you can contact Ground Transport on 08 6488 8582 or submit futher information at [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.

Report Type(Required)

Report a NEAR-MISS or if a vehicle requires MAINTENANCE and/or minor damage repair or report an ACCIDENT involving other people, vehicles or proptery.

Near-miss

Maintenance

Accident

Incident Time and Location

Incident Date(Required)

The date the incident occurred or was identified.

MM slash DD slash YYYY

Incident Time(Required)

The time the incident occurred or the hazard was identified. 24 Hour Format.

Hours

Minutes

Incident Area(Required)

City or town country state or described area

Streets(Required)

The street or intersecting streets where the incident ocorrued.

Person Notified(Required)

The supervisor or manager or ground transport person you notified.

Notification Method(Required)

How you notified your supervisor or manager or ground transport.

Text

Call

In Person

Slack

Driver of Festival Vehicle (Driver One)

Driver One is the driver and reporter of the incident and may be driving a Festival owned or hired vehicle.

Driver One Name(Required)

The Festival driver’s name as shown on the Driver’s licence

Driver One Contact(Required)

The Festival driver’s mobile phone number

Driver One Email(Required)

The Festival driver’s email

Driver One Vehicle(Required)

Make model and registration plate number and identifying features of the vehicle.

Speed Vehicle One(Required)

Speed of reporters vehicle in KPH at time of accident.

Traffic ControlsvVehicle One(Required)

What traffic controls apply, speed limit, warning signs, road markings.

Near Miss(Required)

Description and details of the near miss.

Maintenance(Required)

Describe the maintenance or repair and information about why and how the event occurred.

Accident Type(Required)

Indicate if the accident involved vehicles, property or other people like pedestrians and cyclists.

Other Vehicles

Other Property

Other People

Injury or death(Required)

Was any driver or pedestrian or other person injured in the incident.

Yes one person

Yes two people

No injury

Damage(Required)

Describe damage to vehicle(s) or property or details of people like pedestrians inolved but not injured.

Other Vehicle Damage (Vehicle 2)

Other vehicle or property involved in the incident, if more than one vehicle please add detail for all cars and drivers and or contact Ground Transport.

Other Driver's Name(Required)

Name of the driver of the other vehicle(s) as shown on driver’s licence.

Other Driver's Phone(Required)

Other Driver's Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Other Driver's licence No.(Required)

Licence number of the driver of the other vehicle

Other Driver's Licence Expiry(Required)

DD slash MM slash YYYY

Other DL State of Issue(Required)

Other Driver's Age

Age of the driver of the other vehicle

Other Insurance(Required)

Name and address or other driver’s insurance company.

Occupants in Vehicle(Required)

How many occupants were in the other vehicle

Other Vehicle Make(Required)

The other driver’s vehice make

Other Vehicle Year(Required)

Estimate year of the other vehicle’s manufacture

Other Registration Number(Required)

Registration plate number of the other vehicle

Other Speed(Required)

Speed of other driver’s vehicle in KPH at time of accident.

Other Traffic Controls(Required)

Describe impact of traffic controls, lights, speed limit, road markings etc.

Property Damage

Owner's Name(Required)

Name of owner of the other vehicle(s)

Owner's Address

Owners address if the other driver is not the owner

Street Address City State / Province / Region ZIP / Postal Code

Owners Contact(Required)

Owner’s phone number.

Police

Police(Required)

Did police attend the incident

Yes

Is police action pending(Required)

Yes

Legal

Police Name(Required)

Name of investigating officer, badge No. and Police Station

Violation Reporter(Required)

Traffic violations charged to the reporter as a result of the incident.

Violation Other(Required)

Traffic violations charged to the other driver as a result of the incident.

Injured 1 detail

Injured 1 Name(Required)

Injured 1 Phone(Required)

Injured 1 location(Required)

Reporter Vehicle 1

Other Vehicle 2

Pedestrian

Injury 1 details(Required)

Describe the injuries

Injured 2 detail

Injured 2 Phone(Required)

Injured 2 Name(Required)

Injured 2 location(Required)

Reporter Vehicle 1

Other Vehicle 2

Pedestrian

Injury 2 details(Required)

Describe the injuries

Witensses

Witnesses(Required)

How many witnesses are you recording

One witness

Two witness

No witness

Witness 1

Witness 1 Detail(Required)

Enter witness name and address

Number(Required)

Witness 1 age(Required)

Witness 1 Phone(Required)

Witness 1 location(Required)

Reporter Vehicle 1

Other Vehicel 2

Pedestrian

Witness 2

Witness 2 Detail

Enter witenss name and address

Witness 2 age

Witness 2 Phone

Witness 2 location(Required)

Reporter Vehicle 1

Other Vehicel 2

Pedestrian

Reporter Statment(Required)

Statement of driver of Festival vehicle, desciption and apparent cause of accident.

File Uploads

Vehicle File Upload

Upload pictures or additional documents.

Max. file size: 10 MB.