VicRoads Field Incident Report

• VicRoads Field Incident Report

• Conducted on

  Date

• Conducted by

• Location
  Address

Field Incident Report

• Type

  Select Early Night Afternoon Mid Day Callout

  • Early
  • Night
  • Afternoon
  • Mid
  • Day
  • Callout

• Vehicle

• Mobile Phone

• Patrol

• Time of callout

  Date

• Time on Scene

  Date

• Incident Lane

• Lanes closed

• Lanes opened

• Cleared

• Location
  Address

• Direction

  Select Inbound Outbound North South East West

  • Inbound
  • Outbound
  • North
  • South
  • East
  • West

• Weather

  Select Clear Storm Fog/Mist Hot (30+) Windy Snow Rain Cloudy

  • Clear
  • Storm
  • Fog/Mist
  • Hot (30+)
  • Windy
  • Snow
  • Rain
  • Cloudy

Breakdown

• Type

  Select Car Truck/bus Motorbike Fire

  • Car
  • Truck/bus
  • Motorbike
  • Fire

• Treatment

  Select Shunt Traffic Management Tow Mechanical Water Jump Start Change Tyre Liquid Spill

  • Shunt
  • Traffic Management
  • Tow
  • Mechanical
  • Water
  • Jump Start
  • Change Tyre
  • Liquid Spill

• Outcome

  Select Hazard Tow Fuel Made own arrangement Tow truck Escort vehicle Gone on arrival Called off enroute

  • Hazard Tow
  • Fuel
  • Made own arrangement
  • Tow truck
  • Escort vehicle
  • Gone on arrival
  • Called off enroute

• Hazard Tow Details

• Tow Company

• Towed to

• Vehicle Details

• Vehicle Rego

• Make of vehicle

• Colour of vehicle

• Company name

• Other (comments)

Collision

• Vehicle 1

  Select Car Truck/bus Motorbike Fire Fatal Collision

  • Car
  • Truck/bus
  • Motorbike
  • Fire
  • Fatal Collision

• Vehicle 2

  Select Car Truck/bus Mororbike Pedestrian Damage to VicRoads asset

  • Car
  • Truck/bus
  • Mororbike
  • Pedestrian
  • Damage to VicRoads asset

• Damage to VicRoads asset (Road Safety Act 1986, Part 6, s.61)

• Name

• Licence No.

• Vehicle Rego

• Make of vehicle

• Model of vehicle

• Colour of vehicle

• Type of damage

• Photos

  Media

• Police Details

• Rank/Name

• Member number

• Station

• Comments

• Signature

  Sign

• Outcome

  Select Shunt Tow Clear debris Traffic Management First aid Liquid spill Gone on arrival Called off enroute

  • Shunt
  • Tow
  • Clear debris
  • Traffic Management
  • First aid
  • Liquid spill
  • Gone on arrival
  • Called off enroute

• Other (comments)

Debris

• Type

  Select Tyre tread Wheel Timber Metal House hold Dead animal Spill Tree/branch Offal Fuel Chemical Lost load from vehiclr

  • Tyre tread
  • Wheel
  • Timber
  • Metal
  • House hold
  • Dead animal
  • Spill
  • Tree/branch
  • Offal
  • Fuel
  • Chemical
  • Lost load from vehiclr

• Outcome

  Select Used absorbent Notified TMC Used chainsaw Removed Gone on arrival Traffic to remove Called off enroute

  • Used absorbent
  • Notified TMC
  • Used chainsaw
  • Removed
  • Gone on arrival
  • Traffic to remove
  • Called off enroute

• Other (comments)

Other

• Please specify

  Select Abandon vehicle Welfare check Check road furniture Pot hole Pedestrian Live stock Assist other agency 'Tagged' Notified TMC Escorted off Traffic Management Self harm Hazard Tow Removed Gone on arrival Called off enroute

  • Abandon vehicle
  • Welfare check
  • Check road furniture
  • Pot hole
  • Pedestrian
  • Live stock
  • Assist other agency
  • 'Tagged'
  • Notified TMC
  • Escorted off
  • Traffic Management
  • Self harm
  • Hazard Tow
  • Removed
  • Gone on arrival
  • Called off enroute

• Hazard Tow Details

• Tow Company

• Towed to

• Vehicle Details

• Vehicle Rego

• Make of vehicle

• Colour of vehicle

• Company name

• Other (comments)

• Other services attended

  Select Police Ambulance Fire SES Depot Contractor TSS Council Traffic Management (private) Towing Traffic Commander Assisted by (other)

  • Police
  • Ambulance
  • Fire
  • SES
  • Depot
  • Contractor
  • TSS
  • Council
  • Traffic Management (private)
  • Towing
  • Traffic Commander
  • Assisted by (other)

• Tow company

• Assisted by (please specify)

• Did you perform a 'Job Safety Analysis'?

  Yes

  No

• Was a display box used?

  Yes

  No

• Was the 'Lane Use Management System' (LUMS) used?

  Yes

  No