Cartage Australia Pty Ltd
ABN 60 108 355 344
PO Box 879 Cranbourne Vic 3977
Tel: (03) 5996 1019 Fax: (03) 5996 6570

Accident Register Form

AT THE EVENT OF AN ACCIDENT

Driver Details

Driver

Lookup

If your Employee Code is not yet in the system please manually add your details below.

First Name *

Last Name *

Email Address *For posting of your record of transaction.

Mobile *Numbers only, no spaces, 10 digits in length.

Driver's Licence Upload

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Accident Details

Accident Date and Time *

Exact Location of Accident *max. 255 characters.

Description of Accident *

Please enter a Trailer and Truck fleet numbers.
You can lookup the fleet number using the registration number if required.

Truck Fleet No.

If Truck not listed please use 999 and enter missing truck identification information.

Truck Registration No.

Lookup

If Truck is 999 and the registration is not known please enter NOTKWN as the value. Max 6 characters.

Truck Vehicle Identification Number *

Trailer Fleet No.

If Trailer not listed please use T999 and enter missing trailer identification information.

Trailer Registration No.

Lookup

If Trailer is T999 and the registration is not known please enter NOTKWN as the value. Max 6 characters.

Trailer Vehicle Identification Number *

Third Party

Person 1 Name

Person 1 Email

Person 1 MobileNumbers only, no spaces, 10 digits in length.

Person 1 Licence Upload

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Person 2 Name

Person 2 Email

Person 2 MobileNumbers only, no spaces, 10 digits in length.

Person 2 Licence Upload

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Person 3 Name

Person 3 Email

Person 3 MobileNumbers only, no spaces, 10 digits in length.

Person 3 Licence Upload

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Witnesses

Witness 1 Name

Witness 1 Email

Witness 1 MobileNumbers only, no spaces, 10 digits in length.

Witness 1 Licence Upload

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Witness 2 Name

Witness 2 Email

Witness 2 MobileNumbers only, no spaces, 10 digits in length.

Witness 2 Licence Upload

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Witness 3 Name

Witness 3 Email

Witness 3 MobileNumbers only, no spaces, 10 digits in length.

Witness 3 Licence Upload

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Police

Have the Police attended? *

YesNo

Date and Time Reported to Police *

Police Officer Name

Police Station

Is anyone injured from the accident? *

YesNo

Please complete a separate Injury/Near Miss/Hazard Incident Report after completing this form.

Description of Cartage Australia vehicle damage *

Pictures of Cartage Australia vehicle damage

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Description of Third Party vehicle damage *

Pictures of Third Party vehicle damage

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Driver Signature *

Draw signature|Type signatureClear

Verify *