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 If the issue concerns a particular vessel, what is the name of the ship? * IMO Number if known: Where did the incident occur On a ship at sea Moorings/Lines Stevedoring Towage industry Ferries Dredging Diving Construction Offshore oil and gas industry - FPSO Offshore oil and gas industry - Drill Rig Offshore oil and gas industry - Support Vessel Port Authority Call centre or office environment Other (please specify) If other, please specify When did the incident occur? * Can you please describe the incident or safety issue? * Why did this occur? 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 If other, please specify please give details of actions taken Images Upload Leave this field blank Submit
