Maritime Security Incident Report Online Form

A completed report submitted to the Department of Infrastructure and Transport using this form will fulfil incident reporting obligations under Part 9 of the Maritime Transport and Offshore Facilities Security Act 2003 (MTOFSA).

This form may be used to assist in making reports to police and other Maritime Industry Participants (MIPs) or Offshore Industry Participants (OIPs).

An incident under Part 9 of the MTOFSA must be reported in writing to the Department as soon as possible. The Department should be notified within 4 hours of the MIP becoming aware of the incident, and the written report should be provided within 72 hours.

You can either use the word version [DOC: 123 KB] and email or fax it to the department (contact details are on the form) or fill out and submit the online form below.

PART 1 - Type of Incident
Maritime Transport or Offshore Facility Security Incident (s. 170 of the MTOFSA) Other Maritime Security Event
PART 2 - Incident Details
Name of MIP/OIP affected:
Location of incident:
Date:
Time:

MIP type (please specify):
Port operatorShip operator Port facility operatorOther Offshore facility operator
If other please specify:

Nature of Incident:
Threat
HijackHoax Suspicious activityInterference with equipment/ facilities MSIC or other ID cardUnauthorised access to a security zone Failure of a screening pointSerious bodily harm / death Unauthorised disclosure of a security planUnauthorised weapons/prohibited items SabotageTheft VandalismOther Extortion
If other please specify:
If applicable, provide name of person / organisation who notified you of this incident:
PART 3 - Ship Details (if applicable and if known)
Check box if unknown or not applicable
Ship's name:
IMO no.:		ISSC no.:
Type:		Size:
Type of Cargo:
Flag:
PART 4 - Building/Structure Identifier (if applicable and if known)
Check box if unknown or not applicable
Insert building number or other identifier:

PART 5 - Incident Narrative and response taken

PART 6 - Other MIPs / OIPs involved

Other Parties involved:

PART 7 - Has the incident been previously reported to the Department's Transport Security Coordination Centre?
Yes No
If Yes, please fill in approximate date/time the Department was notified:
Date:
Time:
PART 8 - If applicable, has the incident been reported to:
State/Territory Police?		Yes No
Affected MIPs/OIPs identified in Part 6 above?		Yes No
If No, please report the incident to those parties in accordance with Part 9, Division 4 of the MTOFSA.
PART 9 - Details of person completing report
First Name:
Last Name:
Position:
Employer:
PART 10 - Other Relevant Information

Timesaver (Time taken to complete form):
Purpose of submitting Report Form
Notification	Purpose of submitting this form is to notify the Department's 'OTS Coordination Centre of a maritime transport security incident or other maritime security event.
Report	Purpose of submitting this form is to provide a report of a maritime transport security incident or other maritime security event.
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Copy Form To: (separate multiple email addresses with semi-colon)

DOC, RTF: To view a Microsoft Word file, you need to have Microsoft Word or Word Viewer installed on the computer. If you do not have the necessary software installed, you can download Microsoft Word Viewer free of charge from the Microsoft website.

Disclaimer: The compatible application(s) listed above are examples only. The Department of Infrastructure and Transport does not endorse any particular software developer or specific application.

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Last Updated: 1 May, 2012