Incidents must be notified to ASNO within 2 hours of detection.     	Ref. No.		
What type of incident was it?	
	
A “security” related incident?	
 “Other” incident?		A “loss of control” incident?		
	Refer to Explanatory Notes on the reverse of this form.	
	
What was affected, and where?    Refer to Explanatory Notes on the reverse of this form
	
Nuclear material?		Associated items?		During transportation?		
	
Details about the incident     If insufficient space, then send attachments
	
Where did it happen?	

Describe the incident:	

		
	
Date & time incident detected:		Earliest possible date & time of incident:			
	
What effect did the incident have?	

		
	
What emergency responses were implemented: 	

	
Which authorities were informed?	

	
Names of Incident Coordinator(s):		Phone number(s):	(	)		
			(	)		
	
Details about the nuclear material or associated item (where applicable)
	
Batch number/item name:		Material category:			
	
General description:	

Signature and permit details	
	
Name :			
	
Position:			
	Signature:	_____________________________________	Date:	____/____/________	
	
Permit Holder:		Permit No:			

Explanatory Notes

Ref.No.		A sequential reference number is required for each form of this type submitted by the Permit Holder (eg, 001, 002, 003, etc).  Where amendments are made to a previously submitted form, please use the same reference with a sequential revision number (eg, 003-Rev.1).	
Incident notification – sequencing of actions	
(1)	In the first instance, all incidents must be notified by phone to the ASNO on-call officer within two (2) hours of detection of the incident.

(2)	Secondly, complete and fax this form to ASNO within four (4) hours of detection of the incident.	
	ACTION	
INFORMATION	

(a)	Phone ASNO on-call officer	
Mobile:	+61 (0)408 423 750	

(b)	Complete / fax this form to ASNO	
Fax:	+61 (0)2 6261 1908	

“Security” related incident		
The tampering with, or breaching of (either partially, or fully), the practical and/or institutional measures designed to prohibit unauthorised access to nuclear materials, associated items or uranium ore concentrates (UOC).  	
“Loss of Control” incident		
The situation in which a permit holder has lost the ability to apply permit conditions—on a continuous basis—to the nuclear material, associated items or UOC.	
“Other” incident		The situation in which external factors (eg, weather) have directly impacted on the approved arrangements for the transportation of nuclear material, associated items or UOC, causing a change to shipment schedules, integrity of the consignment, approved containerisation arrangements, approved transportation arrangements, approved vessels and/or the approved transportation route.	
Date and time of incident		
Provide the date and time the incident is determined to have occurred.  Where this is not known, the last time control of the nuclear material, associated item of UOC was verified.	
Signature		This form must be signed by a representative of the Permit Holder (ie, the organisation) who will take responsibility for, and sign documents on behalf of, the organisation.	

		
		
This form replaces the following forms 	ASO201 (version 3 - issued 22 July 2010), ASO202, ASO209, ASO216, ASO217 and ASO221