Published on Australian Maritime Safety Authority (https://www.amsa.gov.au)

Suspected non-compliance reporting form

Use this form to notify us about suspected deficiencies on vessels. This form is intended to be used by pilots, stevedores, port authority officers, and other third parties.

Ship's details

Name of ship

IMO number

Flag

Ship's agent

IMO company number

Company's name

Company's address

Berth

Estimated time of departure

Next port

Place of observation

Date of observation

Day

Month

Year

Time of observation

Hour

Minute

Contact details

(We treat name and contact details as confidential. These details are requested in case we need to contact you for further information about suspected deficiencies. We follow up on all reports).

Name

Position

Phone

Fax

Email addresses *

Pilotage concerns

Bridge equipment/operations

Pilot ladder arrangements

Helicopter operations

Draughts and trim

Handling of tugs

Other (specify)

Operational concerns

Possible pollution threat

Vessel conditions

Vessel access

Mooring arrangements

Stability draughts and trim

Machinery

Other (specify)

Port authority concerns

VTS/VTIC

Vessel safety

Other (specify)

Cargo operational concerns

Cargo or cargo operations

Dangerous goods

Other (specify)

Brief description of concerns/comments *

Leave this field blank

Having difficulties?

If you have difficulty submitting this form online, you can print it and fax the completed form to: 02 6279 5940. This number is checked only during normal business hours. See our contact numbers for other options.

Source URL: https://www.amsa.gov.au/vessels-operators/general-incident-reporting/suspected-non-compliance-reporting-form