Development Application part 2 OF 2 All of CD, Information in notes - MCU12/0216

                                    EMERGENCY AND INCIDENT
              Department of Environment and Heritage Protection Initial Notification Form
This form is to be completed when notifying the Department of Environmental and Heritage Protection (EHP) of any emergency or incident,
which has or may cause environmental harm. The EHP is to be contacted by telephone or facsimile (of this form) within 24 hours after
becoming aware of the emergency or incident.



    Date ..............................................................................................................................................................................
    Holder of Approval ......................................................................................................................................................
    Operators Name ...........................................................................................................................................................
    Your Name ...................................................................................................................................................................
    Site Location ................................................................................................................................................................
    Location of emergency or incident within Site ...........................................................................................................
    ......................................................................................................................................................................................
    Licence Number/Development Approval ....................................................................................................................
    Name and telephone number of Contact Person ........................................................................................................
    ......................................................................................................................................................................................
    Time of the emergency of incident ..............................................................................................................................
    Time that operators became aware of the incident .....................................................................................................
    The suspected cause of the emergency/incident .......................................................................................................
    ......................................................................................................................................................................................
    The environmental harm caused, threatened, or suspected to be caused by the incident
    ......................................................................................................................................................................................
    ......................................................................................................................................................................................
    ......................................................................................................................................................................................
    Actions taken to prevent further environmental harm and mitigate any environmental harm
    caused by the incident
    ......................................................................................................................................................................................
    ......................................................................................................................................................................................
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