Vessel owner Business Name
Contact Name
Mobile Number
Email
Vessel Name
Address
Description of Works
Contractor Name (if applicable)
QBCC Number
Contractor Mobile Number
Contractor Email
Details:
Proposed Start Date and Time
Proposed Finish Date and Time
High Tide Time
Low Tide Time
If you ticked YES to any of the above 6 questions, please provide details of the intended control measures and precautions to minimise risk:
Comments - if NO was ticked to any of the above 9 questions, please provide details of an alternate procedure with control measures
If NO, Vessel Owner/Contractor is to provide a report from a suitably qualified consultant that the works undertaken do not pose any environmental harm to the Port of Karumba
If YES, prior access arrangements are to be made with the MSQ / Port Officer
If NO, recitify prior to tidal inundation, and MSQ / Port Officer is to document/photograph any non-compliance with clean up and retain on file
Name of Vessel Owner / Master
Date