Landholders and community

Use this form to report a suspected incident in relation to a mineral and energy resources activity.

* Indicates a mandatory field

Personal details

(include area code)
Preferred contact

Suspected source

Resource activity

Please select the relevant resource activity *

Issue category

Issue category * Select one or more category.

Complaint details

Describe the issue, including date and time. 1000 character limit.
If different from above.
Have you contacted the person/company/business about the problem? *
Do you give permission for your details to be released to a third party if the matter needs to be referred? *

Declaration

I understand that all information supplied on or with this application form may be disclosed publicly in accordance with the Right to Information Act 2009, the Information Privacy Act 2009 or the Evidence Act 1977.

I declare that the above information I am supplying is true and correct *
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