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Incident Report Form

 

 

Fields marked with an asterisk (*) must be completed
Person Making Report
Phone Number
Person/s Involved in Incident (if different to above)
Incident Details
RadDatePicker
RadDatePicker
Open the calendar popup.
RadDatePicker
RadDatePicker
Open the calendar popup.
Weather conditions at the time * (required)



Other
Did anybody else see the incident * (required)
Did any person need medical attenion? * (required)
Is this the first notice of the incident to Council? * (required)
Everyone must fill in this section
Do you give permission for Council to forward any claim to a third party if needed? * (required)
Please enter the code from the image to continue

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    Privacy Statement

    The East Gippsland Shire Council asks for details about you to collect rates, approve permits and licences, and run a range of community services.  The information you give to us on this form is used only for the reasons set out in the form and is not given to anybody else. Sometimes we may supply details about you to someone else, but only if we are allowed by law, or to protect someone or property.

    When information is given out, Council will always try to make sure your privacy is protected in line with the Privacy and Data Protection Act 2014.  You may ask for more information about Council’s Privacy Policy by contacting our Information Privacy Officer on 03 5153 9500 or e-mail feedback@egipps.vic.gov.au

     

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