Title Page

  • Title of Investigation

  • Completed by

  • Position of Completing Officer

  • Commenced on

Investigation

  • Participating Officers

  • Type of Investigation

Complainant's Details (leave blank for anonymous)

  • Name

  • Address

  • Email

  • Phone Number

Nature of the Complaint

  • What is the complaint related to?

  • Description of the complaint

  • Is the address relating to the cause of the complaint known?

  • Address

  • Description of the area

  • Description of the timing of the alleged unlawful activity (dates, times, frequency), if known.

Records of conversations

    Conversation with Complainant
  • Time and Date of Conversation

  • Purpose of conversation

  • Notes from conversation

  • Conversation with alleged offender
  • Time and Date of conversation

  • Alleged Offender's Name

  • Alleged Offender's Address (if known)

  • Alleged Offender's Contact Number (if provided)

  • Purpose of conversation

  • Notes from conversation

  • Conversation with witness
  • Time and Date of conversation

  • Witness Name

  • Witness Address (if known)

  • Witness Contact Number (if provided)

  • Notes from conversation

Observations: Notes and Photographs

    Observation
  • Description

  • Time and Date of Observation

  • Photo (when possible)

Conclusions

  • Summary of Findings

  • Recommended enforcement action

  • Completing Officer's Signature

  • Time of Completion

Staff Member's Details

  • Name

  • Position

  • Email

  • Phone Number

Nature of the Complaint

  • What is the complaint related to?

  • Description of the complaint

  • Is the address relating to the cause of the complaint known?

  • Address

  • Description of the area

  • Description of the timing of the alleged unlawful activity (dates, times, frequency), if known.

Records of conversations

    Conversation with referring Staff Member
  • Time and Date of Conversation

  • Purpose of conversation

  • Notes from conversation

  • Conversation with alleged offender
  • Time and Date of conversation

  • Alleged Offender's Name

  • Alleged Offender's Address (if known)

  • Alleged Offender's Contact Number (if provided)

  • Purpose of conversation

  • Notes from conversation

  • Conversation with witness
  • Time and Date of conversation

  • Witness Name

  • Witness Address (if known)

  • Witness Contact Number (if provided)

  • Notes from conversation

Observations: Notes and Photographs

    Observation
  • Description

  • Time and Date of Observation

  • Photo (when possible)

Conclusions

  • Summary of Findings

  • Recommended enforcement action

  • Completing Officer's Signature

  • Time of Completion

Incident Report Details

  • Type of Incident

  • Address of pollution source or description of source area

  • Description of the extent of the affected area

  • Is the person who made the report known?

  • Reporter's Name (first and last name)

  • Reporter's Phone Number

  • Reporter's Email

  • Reporter's Address

Records of conversations

    Conversation with Reporter
  • Time and Date of Conversation

  • Purpose of conversation

  • Notes from conversation

  • Conversation with suspected polluter or other responsible party
  • Time and Date of conversation

  • Nature of the person being spoken to

  • Name of Individual

  • Is the individual representing a company or other organisation?

  • Have they confirmed they may speak on behalf of the company/organisation?

  • Proceed with the conversation.

  • Company/Organisation ABN (if known)

  • Company/Organisation Address (if known)

  • Company/Organisation Contact Number (if known)

  • Conversation may still be had, but you should avoid questions about company/organisation policies, procedures, business details, or the nature of their employment. Focus on the individual until an appropriate contact for the organisation is found.

  • Individual's Address (if known)

  • Individual's Contact Number (if provided)

  • Purpose of conversation

  • Notes from conversation

  • Conversation with witness
  • Time and Date of conversation

  • Witness Name

  • Witness Address (if known)

  • Witness Contact Number (if provided)

  • Notes from conversation

Incident Observations: Photos and Notes

    Observation
  • Description

  • Time and Date of Observation

  • Photo (if possible)

Containment

  • Were containment measures required?

  • What teams were involved in installing containment measures

  • Containment Measure
  • Description

  • Time and Date of installation

  • Photo (if possible)

  • Why was containment not required?

Clean-Up

  • Is clean-up action required?

  • Has a verbal Clean-Up Notice been issued to the responsible party/parties?

  • Who was it issued to?

  • What did the clean-up Notice require them to do?

  • Is the responsible party taking clean-up actions themselves, or engaging Council to do so on their behalf? (knowing they will be billed for the costs associated)

  • Monitor the clean-up works and continue to liaise with responsible parties to ensure the clean-up is effective.

  • What teams are involved in clean-up action?

  • Clean-Up Action
  • Time and Date of Commencement

  • Description

  • Photo (if possible)

  • Is the responsible party unknown?

  • Issue the verbal clean-up Notice to the responsible party and ask if they can arrange clean-up themselves or would like to engage Council to do so on their behalf. Advise Council will charge them for the associated costs.

  • Council to commence clean-up action until a responsible party can be identified.

  • Why was clean-up not required?

Conclusions

  • Summary of Incident and actions taken

  • Recommended enforcement action

  • Completing Officer's Signature

  • Time Completed

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.