Section 1

Notifier *
Are you are the operator of the facility in question

Category *
Environmental Damage or Imminent Threat of Damage Does your submission relate to environmental damage which has already occurred or to an imminent threat of damage which has not yet occurred

Notifier Details

First Name *

Last Name *

Your Organisation Name *

Submitted by Organisation *
Are you submitting this complaint on behalf of the above named Organisation.

Address Line 1 *

Address Line 2

Address Line 3

Town / City *

County *

Eircode/Postcode

Phone Number *

Email Address *

Operator Details

Please complete the form below and click on save when you have completed the details.

First Name *

Last Name *

Organisation Name *

Address Line 1 *

Address Line 2

Address Line 3

Town / City *

County *

Eircode/Postcode

Phone Number *

Email Address *

Fax

Licence Number

NACE Code

Environmental Damage Location Details

Name of Activity/Location *

Address line 1 *

Address line 2

Address line 3

Northings

Eastings

Town / City *

County *

Eircode/Postcode

Local Authority *

Details of Environmental Damage/Imminent Threat of Damage

Notification Details *
"Please supply the fullest possible account of facts giving rise to the notification including full details. The description should be as specific as possible and concentrate on the facts surrounding the environmental damage or Imminent threat of damage.You must also include details of the imminent threat, the preventive measures taken and the outcome of preventive measures. Please outline specific dates and times and duration of any incidents/emissions and when you became aware of the incident".

Other Authorities
"Details of any approaches that you already made to other authorities (e.g. Local Authority, Department of the Environment, Heritage and Local Government, Fisheries Board, European Commission). Please include copies of your correspondence with this form":

Legal and Insurance
"Details of any court or other legal actions or insurance claims in relation to the environmental damage":