Docstoc

INCIDENTDAMAGE REPORT FORM

Document Sample
INCIDENTDAMAGE REPORT FORM Powered By Docstoc
					Cardinia Shire Council Incident/Damage Report Form

This report completed as soon as possible after damage is discovered to Council property
(however minor). Upon completion, this form should be forwarded to the Insurance Advisor
at Cardinia Shire Council on Fax: 5945 4209 or post to P.O. Box 7, Pakenham, 3810.

                         COMMITTEE MEMBER TO COMPLETE (PLEASE PRINT)

Name:                                                Title:
Date and Time damage occurred:                   /            /200        at                       a.m/p.m.
Describe the weather/conditions at the time the damage occurred:


Description of Damage:




Was any person injured?                                 Yes            No     
If so, please describe injuries and follow up action (ie. first aid applied, ambulance called)




Details of Witnesses:
 Name                                      Address                                     Phone No.




Signature:                                                                     Date:        /      /200
   FORWARD THIS REPORT TO THE INSURANCE ADVISOR AS SOON AS POSSIBLE


db0cdb77-c1e6-4bda-bead-cdcc42436ef8.doc                                                           Page 1 of
                        INSURANCE ADVISOR TO COMPLETE (PLEASE PRINT)

Name:
Position Title:
Date Report Received:                      /          /200
Comments:



Advise Insurer immediately if it seems likely a claim will be made.


Signature:                                                                              Date:          /      /200
            HAND THIS REPORT TO THE BUILDING MANAGEMENT OFFICER.

                           BUILDING MANAGEMENT OFFICER (PLEASE PRINT)

Name:
Position Title:
Date Report Received:                      /          /200
Comments/Action:




Signature:                                                                              Date:          /      /200

INSURANCE ADVISOR/BUILDING MAINTENANCE OFFICER TO COMPLETE (PLEASE
PRINT)

Date considered :                  /           /200
Comments:


Action:


Officer Responsible for Action:
Progress Comments by Responsible Officer:
                                                                                    Date:        /         /200
                                                                                    Date:        /         /200
Action Completed:                                                                   Date:        /         /200


Signature:                                                                          Date:        /         /200

FILING:                Copy of Report to Building Management Officer
                                      Copy of Report to Insurer with Claim Form (if claim required)
                                      Original to Records (Material Damage Claim file 05-15-15)

db0cdb77-c1e6-4bda-bead-cdcc42436ef8.doc                                                                     Page 2 of
PUBLIC LIABILITY CLAIMS MANAGEMENT PROCEDURES

Introduction

All incidents that are potential claims need to be handled properly as soon as they occur. A detailed
investigation must be carried out, and the procedures to be followed when a claim is made are set
out in this section. Council should be advised immediately of any incident which may result in a
claim.

When a potential claim situation arises, any suspicions or unsubstantiated allegations should also be
included in information for Council. If there is anybody with a first hand knowledge of the
circumstances involved, that person's opinion is invaluable, and the names of any witnesses should
also be included.

                                           Remember, if in doubt report it.

The Committee should nominate one person to deal with Council in relation to any incidents which
may result in a claim, and that person should feel free to contact the Council at any time to find out
the progress of any claim. The Council is committed to working with the Committee to resolve any
situations which arise, and if the Committee has further information, or requires any information, they
should immediate contact the Council.

Claims and legal documents

If a claim, solicitor's letter or some other legal document arrives in the mail or is served on you, don't
panic. Don't reply to the letter or claim yourself. Don't make any remarks or comments about the
incident to the person delivering the letter or claim. Make a note of how the claim arrived, by mail or
by hand. If by hand, make sure you make a note of who delivered it.

Contact either Jan Bayliss or Bob Hannah at Council as soon as possible, and send the letter or
claim documentation. Attach any relevant incident report, plus names of witnesses and any notes or
photos relating to the incident to Council. Any action you take should be under the guidance of
Council.

If a person demands compensation

If an angry or upset person confronts you in a reserve or rings you - remain calm. Treat the person
politely. Take notes about what they are saying. Do not admit responsibility for any incident. Ask
the person to submit the claim in writing to the Council. Contact the Council about the incident and
follow the course of action recommended. It is most important that you remain calm and treat the
person politely. You need to find out as much information as possible from the person and fill in an
incident report form to be forward to Council as soon as possible.

Liability claims procedure

Where a member of the public is injured or has property damaged, action needs to be taken to
minimise further risk to the public. It is also important to reduce the chance of a claim being made or,
if a claim is made, minimising the compensation that may be due.

All claims should be treated as if they were genuine. It is not the Committee’s responsibility to decide
whether the claim is genuine or false. All claims should be immediately directed to Council.

Because a claim may not arise for years after an incident has occurred, it is important that as
much information as possible is recorded at the time that an incident occurs. If you wait until a
claim has been made before you conduct an investigation, it may be almost impossible to find out
what happened and what the conditions were at the time the alleged incident occurred.

First aid and medical care should be provided immediately a member of the public is injured. It is
important that prompt and proper care be taken of the injured person.
db0cdb77-c1e6-4bda-bead-cdcc42436ef8.doc                                                          Page 3 of
While providing first aid, or after calling for a doctor or ambulance, find out as much as you can from
the injured person about what happened and where.

You will need to complete an incident report form. To complete the form you will need to:

       Obtain names and addresses of witnesses before they leave the scene. If possible, have the
        injured person point out exactly where the accident occurred.

       Interview witnesses, employees or people working in the area about the incident.

       If there are damaged fixtures or poor quality repairs, for example, in the area where the incident
        occurred, then make sure the area is guarded, blocked off and/or signposted until repairs are
        made.

       Record or note items relating to the incident. For example: floor or ground condition (slippery,
        wet, rough etc.); Lighting (was the sun low, shadows, dark, well lit etc.); Weather, if outdoors, or
        if wet outside whether water etc. was carried into building; the number of people in the area;
        equipment or facilities (seats, taps, tables etc.) in the area including portable and fixed or
        permanent facilities.

Note also as much information as you can about the injured person, including where possible; what
the injured person said; what was the cause of the incident; type of clothing worn by the injured
person; whether spectacles were worn (or contact lenses); type of footwear and condition of the
footwear; whether a walking stick, walking frame or other aid was used; whether there were any
substances on the person's clothing or shoes; emotional state of injured person prior to incident (if
possible); whether the injured person was intoxicated.

Complete the incident report form at the earliest possible time but within 24 hours of
the incident occurring.

Where a serious or potentially serious incident occurs, report it to the Council as soon as possible by
telephone on 5945 4205, followed by a written report.

Where new information or witnesses are found (at any time after the injury occurred), these should
be reported as soon as possible to the Council.

What should NOT be done

To help reduce the likelihood of unnecessary claims being made, there are a number of things that
should not be done.

    Do not admit responsibility for any incident.
    Do not offer to pay any medical or other expenses.
    Do not agree that any equipment or facilities were faulty.
    Do not blame other Committee members, the Council or other parties
    Do not apologise for the incident.
    Do not argue or discuss the cause of the incident with the injured person or witnesses.
    Do not conduct the investigation or fill out the incident report form in the presence of the injured
     person.
    Do not discuss the incident at any time with people who have not been positively identified as
     representing the Council. If in doubt, check.




db0cdb77-c1e6-4bda-bead-cdcc42436ef8.doc                                                            Page 4 of
PROPERTY (MATERIAL DAMAGE) CLAIMS MANAGEMENT PROCEDURES

Introduction

Material Damage claims are all those where damage is caused to a Council building (or contents
where the contents are insured by the Council). It is important to note that the excess on Council’s
insurance policy is $2,000, and the Committee of Management is responsible for this amount, unless
they can prove financial hardship to the Council. The types of damage that are included in this
insurance are fire, storm damage, flood or vandalism/criminal damage, etc.

It is important that the Council is notified immediately of any damage to a Council building so that
Council staff can ensure that the building is made safe and secure, and then the damage can be
assessed.

You should contact either the Building Management Officer, 5945 4337, the Insurance
Advisor, 5945 4205 or the Risk Management Co-ordinator, 5945 4346 as soon as
possible to report the damage.

If the damage has caused a serious hazard to public safety, then it should be blocked off or guarded
until Council staff are able to put in place proper safety fencing. To ensure the safety of all people,
only emergency personnel (ie CFA, Police, SES) should be permitted on the site, until it has been
declared safe by those personnel.

The attached Incident/Damage Report form should be filled out at the earlierst opportunity to ensure
that as much information is obtained as possible. This will also assist in hastening the processing of
the insurance claim.

If the Council holds contents insurance for your Committee, then it is prudent to maintain an up to
date list of all contents in the building. If any other user group has contents in the building, you
should advise them to have their own contents insurance, and maintain a list of all those contents.




db0cdb77-c1e6-4bda-bead-cdcc42436ef8.doc                                                       Page 5 of

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:14
posted:3/14/2011
language:English
pages:5