Use this form if you are responsible for goods or a vehicle (aircraft or vessel) carrying goods that are under biosecurity control or an exposed goods order. You must submit this form if you become aware of a reportable biosecurity incident involving the goods. This report is required under the Biosecurity Act 2015. Section A: Type of event You are responsible for the: Goods Vehicle (aircraft or vessel) carrying the goods Which type of event best describes the incident? Select all that apply The goods don’t match the details on a manifest or an import permit. The goods were in a damaged container, vehicle or storage area and are no longer secure. The goods have been lost or stolen. The goods were destroyed without direction from a biosecurity officer. A change to the intended use of the goods. The goods or their container, vehicle or storage areas may have been exposed to contamination, infestation or infection. The goods are infested with a live pest (for example, an insect, invertebrate or other animal). Required biosecurity measures (under Chapter 3 of the Act) have not been taken. For example, because they were missed or not possible to complete. Other (please specify) If other, describe Section B: Name and contact details First name Last name Phone Email Address Suburb State or Territory - Select -ACTNSWNTQLDSATASVICWA Postcode Section C: Goods details Description of goods Briefly tell us what the goods are. Include what they are, the quantity, and how they’re packed. Example: 200kg of fresh mangos, Reference number (AIMS, permit number or other) Section D: Location of incident Address Suburb State or Territory - Select -ACTNSWNTQLDSATASVICWA Postcode Specific location Have the goods been moved since the incident? Yes No Current address of the goods Suburb State or Territory - Select -ACTNSWNTQLDSATASVICWA Postcode Section E: Details of incident When did you become aware of the incident? (Date) Time Description of incident Describe what happened and what caused the incident. Steps taken to manage incident Describe what’s being done to manage the risk (if applicable). You can also include possible root causes and any actions taken to prevent a reoccurrence. If you were unable to report the incident immediately, please explain why Upload image 1 Upload You can upload up to 2 images (jpg, gif, png) and they should be no larger than 5 MB each.One file only.5 MB limit.Allowed types: gif jpg png. Upload image 2 (optional) Upload Optional second image (jpg, gif, png, max 5 MB).One file only.5 MB limit.Allowed types: gif jpg png. Section F: Details of person/s who may have information about the incident Person 1 Person 1 First name Last name Phone Email address Address Suburb State - None -ACTNSWNTQLDSATASVICWA Postcode Add another person Section G: Privacy notice Personal information’ means information or an opinion about an identified individual, or an individual who is reasonably identifiable. We collect your personal information for the purposes of assessing your application and related assessment. Incomplete or incorrect information on the application will mean the application is unable to be assessed. If you do not provide some or all of the personal information requested, we will be unable to contact you to discuss or respond to your submission. Personal information may be published on our website, disclosed to parliament, other Australian agencies, persons or organisations where necessary for these purposes, provided the disclosure is consistent with relevant laws, in particular the Privacy Act 1988. Your personal information will be used and stored in accordance with the Privacy Principles. See our Privacy Policy to learn more about accessing or correcting personal information or making a complaint. Alternatively, phone us on +61 2 6272 3933. Confirm that you have read and understand this privacy notice. Acknowledgement By submitting this application, the applicant declares the information provided is true and correct at the time of submission and that it is a criminal offence under the Criminal Code Act 1995 to knowingly give false or misleading information to an Australian Commonwealth officer exercising powers under Commonwealth law. This offence carries a maximum penalty of 12 months’ imprisonment. Submit
