City of Cockburn, PO Box 1215, Bibra Lake DC, Western Australia, 6965
Telephone: (08) 9411 3444

CoSafe Holiday Watch Form

This form must be submitted 5 working days before your holiday commences.

Please ensure that all the details that you provide are correct and that your nominated Emergency/Key holders are aware of their nomination and they are fully aware of the Co Safe Service contact number (1300 267 233), should they require any assistance whilst you are away.

A Pdf form is also available for filling out and you will need to drop/post this into Council with your Holiday Watch details


* denotes a required field

* Name:

* Address:

* Email:

* Phone:

 

* My Contact number whilst away:

 

* I will be away from home from:

* Until the following dates:

Emergency/Key Holder Details:

(1) Name:


Phone:(H)

Phone:(W)

REGO:

Vehicle Type/Make:

(2) Name:


Phone: (H)

Phone:(W)

REGO:

Vehicle Type/Make:

Do you anticipate anyone visiting the property whilst you are away eg. plumbers, builders, lawn mowing? If so please provide details of those people:

Name:

Contact
Phone:



Name:

Contact
Phone:


Will there be a car in the driveway?

(Yes / No)
REGO:
Vehicle Type/Make:
Note: If you return earlier than the time specified on this form
you must notify the CoSafe Office on 9411 3387 or 9411 3384

Please enter the characters from the image(s) below.

If you are having trouble reading the text, then click the refresh button above the speaker icon, or click the speaker icon to listen to the audio instead.

Check List

  • Set Timers on lights

  • Is House alarmed and if so please notify monitoring company that you will be away

  • Do you anticipate anyone visiting the property whilst you are away?  eg. plumbers, builders, lawn mowing.

Note:  If you return earlier than the time specified on this form you must notify the CoSafe Office.

Contacts: Community Safety Officer
T: 9411 3387 or 9411 3384
E: customer@cockburn.wa.gov.au