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JWS Staff Online Forms
JWS Online Forms
JWS Staff Online Forms
Submit a ticket
Initial Incident Report Form
Submit a Support Request
Required fields are marked with
Name:
Email:
Priority:
Low
Medium
High
Subject:
Driver's/Employee's Name:
Date of Incident:
Approximate Time of Incident (24hr format):
Terminal/Site/Location:
Contract:
Shell
Phillps66
Tankshare
If Tankshare/Petroloads name of customer:
Full Vehicle Registration Number:
Full Trailer Number:
Where was the driver when he noticed the issue/incident?
Has the Driver's statement been attached?
Yes
No
Site Name/Incident Location (Motorway, A Road etc):
Please give a full detailed account of the incident(s):
Region:
Midlands
North East
North West
Scotland
South East
South West
Weather:
- - Click to Select - -
Cloudy
Rain
Snow/Ice
Fog/Mist
Sun
Windy
Any witnesses?
Yes
No
If yes, please give witness details:
Loaded or empty:
- - Click to Select - -
Loaded
Empty
Was Drug & Alcohol Testing required and called?
Yes
No
Was this incident reported by the Driver?
Yes
No
Has this been reported to the customer? (Shell/P66/Tankshare customer):
Yes
No
Has the Emergency Services been called?
Yes
No
Have any pictures been taken at the scene (if so please attach):
- - Click to Select - -
YES
NO
Is CCTV/FFC footage available?
Yes
No
Maybe
Is there a copy of the Pre-start Check Sheet? If so please attach:
Yes
No
Is there a bump card? If so please attach:
Yes
No
Is there any damage to a company vehicle or property:
Yes
No
Is there any damage to a third party vehicle or property:
Yes
No
Any other information you would like to give?
Attachments:
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