1. Incident details
2. Pollution details
3. Attachments
4. Original report source
5. Sender details
Marine Pollution Report (POLREP)
Incident details
Date and time of incident
Location Description
Latitude
Decimal degrees
Decimal degrees
Degrees & decimal minutes
Degrees, minutes & seconds
°
'
''
Longitude
Decimal degrees
Decimal degrees
Degrees & decimal minutes
Degrees, minutes & seconds
°
'
''
Incident description
Next step
Pollution details
Pollution Source
(choose)
Vessel
Land
Other
Unknown
Vessel type
(choose)
Tanker
Container
Bulk cargo
Fishing
Defence
Recreational
Other
Vessel name
Total fuel onboard (litres)
Flag state/call sign
Australian vessel
(choose)
Yes
No
Pollutant
(choose)
Oil
Chemical
Garbage
Packaged
Sewage
Other
Type of oil
(choose)
Bilge
Diesel bunker
HFO bunker
Crude
Unknown
Other
Name of chemical
MARPOL cat./UN Nos
Details
Amount of pollutant (litres)
Size of spill (metres)
Has discharge stopped?
(choose)
Yes
No
Unknown
Is assistance for an investigation required from Transport
(choose)
Yes
No
Response action taken
(choose)
Yes
No
Response details
Weather conditions of site
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Next step
Attachments
File
Details/description
Held by
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Original report source
Name of report source
Position
Phone
Alternate contact method
Combat agency
Statutory agency
Equipment used
(choose)
AMSA
State/NT
Further possible action
(choose)
Legal
AMSA assistance
Other
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Sender details
Name
Agency
Phone
Fax
Email
Date
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