SUPPLEMENTARY INFORMATION FORM
Any person who reports a possibly illegal dumpingincident should, where possible, provide the following supporting information:
I ADDITIONAL INFORMATION ABOUT THE INCIDENT
A. Identification/Registration No. of Dumping Vessel or Aircraft:
B. Dumping Vessel Estimated Hull Length: (meters) Breadth: (meters)
C. Description of Dumping Vessel or Aircraft:
D. Incident observed from: ! Vessel ! Aircraft ! Land
E. Name and Registration Number of the Incident Observerís vessel or aircraft (where applicable):
F. Is navigation data available for the dumping vessel or aircraft? ! Yes ! No
If yes, provide copies with report.
G. Are video tape recordings of the incident available? ! Yes ! No
If yes, provide copies with report.
H. Are photographs of the incident available? ! Yes ! No
If yes, provide copies with report.
II OBSERVATION INFORMATION AND CONDITIONS
A. Information on the location of the Incident Observer during the observations
Date: Time:
Latitude: | Degrees: Minutes: Seconds: | ! North | ! South |
Longitude:: | Degrees:: Minutes:: Seconds:: | ! East | !West |
Observation Platform(vessel or aircraft): Course (degrees):
Speed (knots):
Distance fromincident (kilometres):
B. Visibility: ! < 0.1 km ! 0.1-0.5 km ! 0.5-1.0 km ! 1.0-2.0 km ! > 2.0 km
! Other (describe):
C. Wind Direction (degrees): Wind Speed (knots):
D. SeaState (Beaufort Scale number & description):
E. Swell Direction (degrees): Sea Height (metres):
III ADDITIONAL INFORMATION ON DUMPING VESSEL OR AIRCRAFT
Owner or Master of Vessel, or Pilotof Aircraft observed dumping (if known):
Name:
Affiliation:
Address:
Telephone: Fax:
Email:
! Unknown
IV ADDITIONAL INFORMATION ONOBSERVED DUMPING INCIDENT
A. Plot the location of the incident and other significant location information on a navigation chart, or available electronic format.
B. Provide as much of the following information as possible:
1. Bearing to Nearest Point of Land fromIncident Site (degrees):
2. Distance fromNearest Point of Land to Incident Site (kilometres):
3. Course and Speed of Dumping Vessel or Aircraft (describe):
4. Was the dumping activity still occurring when the Incident Observer left the
scene?
! Yes ! No ! Unknown. Explain:
5. In the Incident Observerís opinion, are humans at risk fromthe dumping incident?
! Yes ! No ! Unknown
6. In the Incident Observerís opinion, is the marine environment at risk fromthe
dumping incident? ! Yes ! No ! Unknown
V. OTHER RELEVANT INFORMATION (use additional pages as needed)