Regulatory-Pollution Notification Form

City of Newcastle acknowledges that we operate on the grounds of the traditional country of the Awabakal and Worimi peoples.
We recognise and respect their cultural heritage, beliefs and continuing relationship with the land, and that they are the proud survivors of more than two hundred years of dispossession.
CN reiterates its commitment to address disadvantages and attain justice for Aboriginal and Torres Strait Islander peoples of this community.

Title:
First Name:
Last Name:
Position:
Company name:
Email:
Phone:
Mobile:
Address:
City / Suburb:
State:
Postcode:
Preferred method of contact:	Letter Email Phone/Mobile Not required
Who is the polluter:
What does the company do:
Is the polluter licensed with the EPA?:	Yes No Unknown
Location of incident:
Pollution cause:	Leak Spill Other
Pollution Other cause:
Pollution impact upon:	Air Water Land
What is the substance (if known):
Quantity / volume / concentration of pollution:
What area is affected / where is it moving to:
What are the impacts (observed / known):
Risks to health or environment:
Duration of incident:
Circumstances in which the incident occurred:	Include cause if known
Action taken or proposed to deal with the incident:
Who else has been contacted:	Emergency / Ambulance (000) Fire / Hazmat (1300 729 579) Police (4929 0999) Port Corp (4985 8321) WorkCover (13 1050) Ministry of Health (4924 6499) - Ask for Public Health Officer on call
Are you seeking any assistance from Council:
Further information (if required):
Date of Incident:	Today
Time of incident:
Upload file:

Regulatory-Pollution Notification Form

Protecting your privacy

Printable Form