Incident Report Form
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Was this reported to a staff member on site? *
Were there any witnesses? *
0/255 characters
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Location *
 

Maximum file size 20MB and one (1) file 
CONDITIONS
Weather *
 
Lighting *
Contributing Factors *
 
Property Damage *
Have you provided two (2) quotes? *
This information is mandatory upon submission.


Personal injuries sustained *
Have you attached invoices for out of pocket expenses? *

This information is mandatory upon submission.
Photographs of damage/injuries? *

This information is mandatory upon submission.
Townsville City Council collects and manages personal information in the course of performing its activities, functions and duties. We respect the privacy of the personal information held by us. The way in which Council manages personal information is governed by the Information Privacy Act 2009 (Qld). We are collecting your personal information in accordance with Insurance Act 1973 so that we can investigate and assess your insurance claim. Generally, we will not disclose your personal information outside of Council unless we are required to do so by law, or unless you have given us your consent to such disclosure. However, in performing the above functions, we may need to disclose your personal information to the Council Insurer and their contacts. For further information about how we manage your personal information please see our Information Privacy Policy.
I agree that the information I have supplied is true and correct. *
Signature - You can use your mouse or stylus to complete your signature.
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Townsville City Council