Incident and Claims Report Form

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Please complete this report immediately upon notification of an event, occurrence or circumstance that may give rise to a claim for compensation for personal injury or property damage.

Do not admit or accept any liability. Please refrain from providing any personal comment and state facts only.

The Duke of Edinburgh’s International Award – Australia (or 'Duke of Ed') engages the services of insurance broker, Honan Insurance Group Pty Ltd (HIG). HIG may be able to assist with your insurance needs, including the policies which the Duke of Ed's Award Centres are required to hold. If you have any queries or would like to obtain further information, HIG may be contacted on DukeofEdinburgh@Honan.com.au.
Honan Insurance Group
Details of person reporting the incident




e.g. Award Leader









Details of Award Centre


Numerals only. Please exclude the prefix (i.e. "AU0000").







Details of injured party

Injured party






This needs to be confirmed separately to determine if Parent/Guardian details are required to complete the form.
Contact details







Parent/Guardian of Injured party

Please note: Injured parties under the age of 18 years old will not be contacted directly.











Details of incident


Enter as XX:XX


For Google Maps: enter the location, select 'Share' and then 'Copy Link'.

Please include any observations or concerns that need to be reported.

Additional details of the injured party




i.e. running, carrying a heavy load, drinking, etc.





Reporter details and actions taken



Enter as XX:XX


e.g. John Smith (Principal)

Person informed of incident

phone and/or email address

e.g. phone, radio, letter, fax, etc.







Additional details

Details of Witness




Details of Award Centre insurance






Details of any Activity or Service Providers

Activity or Service Providers






Details of any Activity or Service Providers Insurance

Activity or Service Providers Insurance






Important notes
If possible, please obtain the following information and indicate how you will share this information with the National Award Office (NAO).
Upload to this form Fax to NAO Email to NAO Unavailable Not applicable

Please upload as one Word (.doc) or Acrobat (.pdf) document.

Please upload as one Word (.doc) or Acrobat (.pdf) document.

Please upload as one Word (.doc) or Acrobat (.pdf) document.

Please upload as one Word (.doc) or Acrobat (.pdf) document.
This information must be provided to the National Award Office by fax (02) 9251 8993 immediately upon completion.

This information must be provided to the National Award Office by email (admin@dukeofed.com.au) immediately upon completion.
Upon selecting "Submit" below, you will be taken to a page where you can review all your responses prior to submission.

To finalise your submission, you will need to select "Submit" from the review page.