Shellfish Aquaculture Licence under the Fisheries Act - Appendix IV: Marine mammal incident report form

This webpage is intended for informational purposes only.

Please report all incidents to O.R.R. Immediately call 1-800-465-4336 or fax 1-604-607-4156

The form below must be completed and submitted within 7 days of the incident.

Company information


Facility Ref. #:

Site Name:

Contact Name:





Reported to ORR Date/time:


Discovery Date/time:

File numbers

ORR #:


Fish Data

Species On Site:



Incident details

Animal condition

Alive, Fresh or Advanced or Moderate decomposition

Incident type

Accidental drowning / entanglement (if unknown describe as best possible)

System component

Predator net, long line, lead line, other (please specify)




Mitigation measures

Describe in detail the mitigation measures in place at this facility to prevent drowning and/or entanglement (these can include infrastructure and/or procedures)


Describe in detail the circumstances that led to the failure of these mitigation measures.


Describe in detail what corrective measures are being undertaken to prevent recurrence of this event. (Please include procedural and/or infrastructural modifications.)


Actions taken with Marine Mammal:

**DFO requests all dolphins & porpoises are collected and stored on ice until arrangements can be made for their collection & necropsy**



Submit the completed form by email to Fisheries & Oceans Canada at: and