Reporting template: Appendix 21 marine mammal incident report form
The plain text on this page is for your information only.
To submit your report, please download the Excel (.xlsx) version and return it to us.
Depending on your browser settings, you may need to right click on the document link and select a ‘save’ option.
Instructions for using this Excel template:
- Go to "Step 1 - General Info" worksheet.
- Select Licence Holder Name from drop-down list
- Then select “Facility Reference No" from drop-down list
- Complete the remaining columns (if applicable)
- Go to "Step 2 - Report Details" worksheet.
- Enter data and complete the remaining columns (if applicable)
- Explain in comments when “Other” is chosen from the pick list
- Data can be copied and pasted into multiple subsequent rows. However, please note that data can not be copied to cells marked "do not enter".*
Colour meaning:
Red - mandatory field (data missing)
Grey - do not enter
White - enterable field
* N.B. in order to maintain data integrity, data from external sources should not be copied directly into greyed-out cells. Please input the data directly into this spreadsheet.
Step 1 - general info
| Licence holder name | Facility reference no. | Facility name | Contact name | Contact phone no. | Contact email |
|---|---|---|---|---|---|
| Pick licence holder (start here) | Pick licence holder before select facility here | Do not enter | input format: first last name | input format: 9999999999 | input format: abc@hotmail.com |
Step 2 - report details
| Incident date | Incident time | Fish on site? (Y/N) | Average weight (grams) | Megafauna species (Common Name) | Incident type | Animal condition | System component | Photos taken? (Y/N) |
|---|---|---|---|---|---|---|---|---|
| input format: YYYY-MM-DD | input format: HH:MM (24hrs) | Pick list | input format: 999999 | (Common Name)Pick List | Pick list | Pick list | Pick list | Pick list |
| Carcass stored pending DFO advice (Y/N) | Animal released (Y/N) | Carcass discarded (Y/N) | Other action taken (Y/N) | Prior mitigation measures | Incident cause | Corrective measures taken | Comments |
|---|---|---|---|---|---|---|---|
| Pick list | Pick list | Pick list | Pick list | 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.) | |
- Date modified: