Title Page
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Conducted on
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Prepared by
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Location
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Time of Contact:
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Please select the relevant local area;
- Port Waratah
- Maitland
- Muswellbrook
- Gunnedah
- Narrabri
- Dubbo
- Binnaway
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Person's Name:
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Stakeholder Contact Number:
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Stakeholder Postal Address:
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Stakeholder Email:
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Method of Contact recieved:
- Face to Face
- Phone Call
- SMS
- Letter
- Social Media
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Please select the stakeholder category:
- Community/Resident
- Business
- Local Authority/Council
- Regulator/EPA
- Media
- Interest Group
- Indigenous Community Interest
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Please select the relevant issue/topic;
- Noise & Vibration
- Dust/Air Quality
- Traffic/Access
- Water/Sediment & Erosion
- Property
- Waste/Rubbish
- Heritage
- Flora and/or Fauna
- Consultation/Communication
- Compliment
- Other (please specify)
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Details of enquiry:
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Please provide details of actions taken including any follow up actions that may be required (if no actions taken please specify the reason):
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(if relevant) Please take photo/s of the issue identified:
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Does this person require further follow-up?
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ARTC Contact Name:
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Contractor/Third Party Contact name and number (if relevant):
