Marine Incident Response Record

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Marine Safety Act 2010 (Vic), Marine  Safety Regulations 2012 (Vic)

This form is to be used by registered marine search and rescue organisations to report a response to a marine incident.
When you submit this report, a copy will be sent to
marineincidents@transportsafety.vic.gov.au as well as the email address you provide.

Description of incident

  1. Date and time (required)








  2. How serious was the incident? (required)

    The list below is ranked in order of severity from top to bottom. Choose the most severe aspect of the incident by selecting only one option.

  3. Location description where the incident initially occurred (e.g. 2 nautical miles SW of Barwon Heads)

    Coordinates - Longitude and latitude of where the incident initially occurred. Degrees, minutes and decimal minutes (to two or three decimal places) S E
  4. How was the incident reported? (required)


  5. Vessels and persons

  6. Was a vessel involved in the incident? (required)

  7. Contributing factors

  8. What factors contributed to the incident? (choose all that apply)
    Human
    Material
    Environmental
  9. Respondents and response details

  10. Provide details of the respondent and response

    Vessel


    Date and time activated (required)
    Time arrived on scene (24 hour) (required)
    Total time spent:


    Action taken (choose one only) (required)

    Additional vessel? (required)
    Additional vessel

    Date and time activated
    Time arrived on scene (24 hour)
    Total time spent on scene:


    Action taken (choose one only)

  11. Details of person who completed this form




Privacy

Transport Safety Victoria (TSV) collects and holds the personal information provided in this application to assist the Director, Transport Safety (Safety Director) to administer the Marine Safety Act 2010 (Vic) and Marine Safety Regulations 2012 (Vic). TSV is committed to protecting personal information in accordance with its obligations under the Marine Safety Act 2010 (Vic). The personal information provided in this form may be disclosed to other government agencies in accordance with section 306 of the Marine Safety Act 2010 (Vic) and section 177 of the Transport Integration Act 2010 (Vic). It is an offence under the Marine Safety Act 2010 (Vic) to give information that is false or misleading.

The individuals whose personal information is collected on this application have a right to seek access to this personal information and to seek correction of any error in the personal information held. All individuals whose personal information is included with this application should be informed of this fact. For more information on privacy please refer to TSV's privacy statement at www.transportsafety.vic.gov.au/privacy.