This form is only for the use of SES units within Cardinia Shire to submit details to Council’s Emergency Management team for follow-up.

SES Secondary Impact Referral Form

Entries with asterisks are required fields

Not all fields are required, but we would appreciate as much information as possible to assist in triaging the case and making referrals to relevant agencies.

Name of Person Filing Report

Property Details

Address

Contact Person Details

Are the property resident's details known
Date and Time of Incident
Are any property, buildings or private assets damaged?
If SES have attended and confirmed damage, select "Damage has been confirmed". If SES has not attended but are submitting this form on the basis of an RFA being received, select "Damage is possible and requires inspection/followup.
Is the property insured?
Provide as much detail as possible to assist in triage. Add photos below if possible.
Are there any hazards present at the property?
This will highlight the case as having an active hazard to field inspectors.

Wrap around supports

Does the primary contact or any other residents have any needs?
This information will help determine the ongoing support needs for the resident.
Emergency housing required (only for residents without insurance and somewhere to stay)
Trauma affected – psychosocial support required
Any other relief need
Drag & Drop Files, Choose Files to Upload You can upload up to 10 files.