Vehicle Safety or Non-Compliance Report
Reported By
Fields marked with an aster (*) are mandatory.
Title
Miss
Mr
Mrs
Ms
Other
First Name *
Last Name *
Organisation (Maximum 100 Characters)
Position
Email *
Phone Number
Postal Street Address
Post Code
Country *
Australia
Other
State
Suburb
Report Type
Fields marked with an aster (*) are mandatory.
Category: *
Other Issues
Safety Issues
Standards Non Compliance Issue
Has there been a death or injury related to this report? *
Yes
No
Subcategory: *
Vehicle Details
Fields marked with an aster (*) are mandatory.
Vehicle Type:*
Component\Part
Motor Vehicle
Other
Trailer
Date Manufactured (mm/yyyy):
Engine / Fuel Type:
Diesel
Electric
Hybrid
LPG
Not Applicable
Other
Petrol
Date Purchased (mm/yyyy):
Make:*
Was the vehicle new or used?
New
Used
Transmission:
Automatic
Manual
Not Applicable
Other
Model:*
VIN / Chassis Number:
Variant:
Approval Number:
Odometer Reading:
Seating Capacity:
Gross Vehicle Mass (GVM)
Gross Trailer Mass (GTM)
Aggregate Trailer Mass (ATM)
Report Details
Fields marked with an aster (*) are mandatory.
Please describe the matter you are reporting. *
Have you reported this matter to the manufacturer, dealer or supplier? *
Yes
No
What was the outcome?
Can this information be disclosed to other parties?
(i.e vehicle manufacturers, state authorities.) *
Yes
No
Report Attachments