Glass Incident Register

All fields marked (*) are required

POPI Act Disclaimer

The Protection of Personal Information Act (POPI Act or POPIA)

The AAAMSA Group is committed to protecting your privacy and to ensure that your personal information is collected and used properly, lawfully and transparently.

This Notice explains how we obtain, use and disclose your personal information, in accordance with the requirements of The Protection of Personal Information Act (POPI Act or POPIA).

The AAAMSA Group values the information that you choose to provide and will take appropriate, reasonable technical and organisational steps to protect your personal information from loss, misuse or unauthorised alteration.

The information made available to the AAAMSA Group concerning its clients, is stored in databases that have built-in safeguards to ensure the privacy and confidentiality of that information.

Please follow the link to our Privacy Notification and Terms and Conditions

- AAAMSA Group Website Terms and Conditions

- AAAMSA Group Privacy Notice Website

I Accept and Understand -

Please Take Note:

The information contained in this register of your glass incident is provided for informational purposes only to improve the general safety of glass in manufacturing and installations for the general public, and should not be construed apportioning liability on any party whatsoever. This is a voluntary submission. We disclaim all liability for actions you take or fail to take based on any content on this site.

I Accept and Understand -

Contact Details of Person Submitting this Incident *

Check if you are the injured party -

Name*

Surname*

Email*

Cell*

Contact Details of Injured Person *

Name*

Surname*

Email - (if applicable)*

Cell*

Age of Injured Person*

Age*

Date and Time of Incident *

Date of Incident *

Time of Incident *

Address where incident occurred *

Complex Name / Business Park *

Street Name + Street No *

Region *

Suburb *

Building Classification *

Select Building Type *

Specify Other Building Type *

Glazing type causing incident *

Select Glazing type *

Specify Other Glazing type Other *

Nature of Injury *

Select Nature of Injury *

Cause of Injury *

Short description of injury *

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