Fill Form – Hunter's Hill Council

Bushcare Volunteer Incident Report (online)

Details of Injured Person
Name*
First Last
Date of Birth
DD slash MM slash YYYY
Address*
Street Address Address Line 2 City
State*
Postcode*
Mobile or best daytime contact number*
Alternative contact number
If seeing a doctor or hospitalised, doctor's and/or hospitals* name
Details of person completing form
Name*
First Last
Relationship to the injured person (Team Leader, Other Volunteer Etc.)
Incident Details
Date*
MM slash DD slash YYYY
Time*

: Hours

Minutes

AM/PM
Where did the incident occur?*
- Council Property
- Other location
Exact Location/Address*
What was the person doing when the incident occurred?*
What happened? (eg fall, exposure to chemical, long term exposure to sun)*
How did the incident occur?*
In your opinion, what could be done to prevent this type of incident re-occuring
First Aid Details (if administered)
Name of person giving first aid*
Mobile Number or best daytime contact number*
Details of first aid treatment given*
Injury Details
Body part injured
Nature of Injury (Fracture, bruise, bite)
Comments
Declaration
Submitting this form is a declaration that the information provided is true and correct in every detail. You have read and understand the terms and conditions.

Hunter’s Hill Council

22 Alexandra Street, Hunters Hill NSW 2110
PO Box 21, Hunters Hill NSW 2110
Tel: (02) 9879 9400
E: customerservice@huntershill.nsw.gov.au
ABN: 75 570 316 011

Bushcare Volunteer Incident Report (online)

Details of Injured Person

Details of person completing form

Incident Details

First Aid Details (if administered)

Injury Details

Comments

Declaration

Quicklinks

Legal

Hunter’s Hill Council