First Name * Last Name * Email * Phone Number What is your role? MUA Delegate Health and Safety Representative Health and Safety Committee Member Concerned MUA Member Other If other, please specify Employer DP World Patrick Terminals Patrick Bulk & General Flinders Ports QUBE Newcastle Stevedores QNI PWCS NSS Bluewater Offshore Towage Lines and Mooring Dredging Diving Ferries Port Workers Other (please specify) If other, please specify Location Adelaide Whyalla Thevenard Port Pirie Port Lincoln Darwin Port Botany Sydney Newcastle Port Kembla Melbourne Geelong Westernport Portland Brisbane Gladstone Bundaberg Townsville Cairns Mackay Weipa Bowen Fremantle Bunbury Dampier/Karratha Broome Esperance Port Headland Albany Geraldton Devonport Hobart Bell Bay Burnie Other (please specify) If other, please specify What is the name of your ship? * IMO Number if known: Type of vessel/cargo * When did the vessel arrive in port? Please list any defects and issues identified * Have there been any previous issues with this vessel? Is the vessel now headed to another port in Australia or New Zealand? Yes No What action has been taken? Local MUA Branch Notified Safety report lodged with company AMSA notified WorkCover/WorkSafe or other authority notified Safety reps/MUA branch in onward port notified please give details of actions taken Leave this field blank Submit
