CD03 - Changing Place Facility Damage Report Thank-you for taking the time to report issues with our accessible equipment and amenities. We appreciate your assistance. Your support ensures we can maintain and continue to provide this important community facility. Applicant Details Name*This field is required. * Required Field. Address*This field is required. * Required Field. Telephone Number*This field is required. * Required Field. Alternate Contact Number Email Address*This field is required. * Required Field.* Please enter a valid email address. Equipment Information Which of the following equipment is in need of repair or servicing? Accessible ToiletAccessible ShowerBeach WheelchairBench SeatChanging TableCeiling HoistPaper Towel DispenserSoap DispenserToilet Paper DispenserOther If you selected Other, please provide more information Damage Details Description of Damage Upload a photo of damage Max File Size: 10.00 MB Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx I have agreed to submit this application by electronic means. I can confirm that the information given in this application is true, complete and accurate. By checking this box and typing my name below, I am electronically signing my application.*This field is required. Please tick here Signature*This field is required. * Required Field. The City of Greater Geraldton collects the personal information you provide in relation to the Changing Place Facility Damage Report form so we can deliver the service, process your request, and meet our legal obligations under the Local Government Act 1995 and any other related legislation. Your information may be shared with government agencies, contractors, or others where authorised by law or with your consent. Where required by law, your personal information will be made publicly available, e.g. public registers. The City manages personal information in accordance with relevant privacy legislation and takes reasonable steps to protect it from unauthorised access or disclosure. You may request access to, or correction of, your personal information by contacting the City at pris@cgg.wa.gov.au. Type the code from the image: Do not fill this textbox. Was this page helpful? How can we improve this page? Email Address*This field is required. * Required Field.* Please enter a valid Email Address Type the code from the image: Do not fill this textbox.