Ref. No.		
Details about the Incident    Refer to Explanatory Notes on the reverse of this form
	
When was the development first detected?	Date:		Time:			
	
Description of the development:			
			
Potential impact of  development:			
			
Actions already taken in response:			
	
Details about the Individual    Refer to Explanatory Notes on the reverse of this form
	
Name:		Title:			
	
Position:			
	
Most recent ASO122 Ref.No for this individual:			

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).	
When was the development first detected		
Developments must be notified to ASNO within 24 hours of the Permit Holder becoming aware of the development.	
Actions already taken in response		
The permit hold should take appropriate actions (e,g restrict further access to nuclear material and/or associated items) ensure ongoing protection of nuclear material and/or associated items.	
Most recent ASO122 Ref.No for this individual		

Not applicable if the Access Authorisation (ASO122) has not reached its first renewal date.	
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 	ASO224 (Original issued 1 January 2002)