Accident/Damages Notification Form
If you would like to notify Hindmarsh Shire Council of damage to property or motor vehicles, or report an accident/personal injury of an individual, please complete this form.
I wish to notify Hindmarsh Shire Council of:
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Damage to property
Damage to motor vehicle
Accident/personal injury to an individual
Other
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Do you wish to receive all correspondence relating to this incident via:
*
Post
Email
Where did the incident occur?
*
Please describe the incident that occurred.
*
Please describe the weather conditions, road condition, speed travelling and visibility at the time of the incident (where applicable):
*
Name and phone numbers of other parties involved/witnesses:
*
Please describe injuries or property damage sustained as result of incident:
*
Where was medical care received?
*
Name of person reporting incident:
*
First Name
Last Name
Signature of person reporting incident:
Clear
Submit
Should be Empty: