Georges River Council - Online Forms

REPORT AN INJURY

Please note: This form does not generate a service request. Please contact Council’s customer service centre if you need more information about how to lodge a service request.

Are you the injured or the reporting person?

Are you the injured or the reporting person?:*

InjuredReporting

Details of Person Injured

Title:*

MrMrsMs

Given Name:*

Last Name:*

Phone No:*

Mobile No:*

Email:*

Place of Injury

Location (Address) of Incident:*

Suburb:*

Postcode:*

Date of Incident:*

Time of Incident:*

What Best Describes the Incident:*

Security code:*

Supporting Documents

Each file size must not exceed 2 MB.

Upload Document - 1:

Upload Document - 2:

Upload Document - 3:

Declaration:*

I agree that all information that I have supplied is true and accurate to the best of my knowledge.

Privacy Notice
Georges River Council is required under the Privacy and Personal Information Protection Act 1998 to collect, maintain and use your personal information in accordance with the Information Privacy Principles. Your personal information is being collected to process your application. Council may use your personal information for the purposes of processing your application. Council is regarded as the agency that holds the information and will not disclose your personal information without your consent unless authorised or required by law. You may apply to access or amend your information by contacting Council on 9330 6400 or at mail@georgesriver.nsw.gov.au