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.

Address
Name of Person Filing Report
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.
Does the primary contact or any other residents have any needs?
This information will help determine the ongoing support needs for the resident.
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