Forms

Environment petroleum forms

Notification of Operator Form - 534 Kb

Instrument holders should use this form to notify DMIRS of the operator of the petroleum, geothermal or pipeline activity. This form should be submitted at the time of, or prior to, submitting the first Environment Plan.

Chemical Disclosure Report - 50 Kb

Use this template to report chemical disclosure.

Emissions and Discharges Reports Form (Quarterly) - 54 Kb

These are required to be submitted every 3 months from the date of the Environment Plan for the activity being approved. Please submit to petroleum.environment@dmirs.wa.gov.au.

Environmental & Reportable Incident/Non-compliance Reporting Form - 64 Kb

Operators are required to submit this report after the reportable incident notification.

Recordable Environmental Incident Report Form (Monthly) - 42 Kb

Use this form to report all recordable incidents occurring within a calendar month no later than 15 days after the end of that calendar month.

Environment minerals forms

Excess tonnage Statutory Declaration - 2567 Kb

statutory declaration

ProForma - Mining Proposal for Small Mining Operations including Mine Closure Plan - March 2020 - 503 Kb

ProForma as per the Statutory Guidelines for Mining Proposals and Statutory Guidelines for Mine Closure Plans – effective 3 March 2020 (word version)

ProForma - Mining Closure Plan for Small Mining Operations - March 2020 - 474 Kb

Proforma to be used for reviewed Mine Closure Plans - as per the Statutory Guidelines for Mine Closure Plans - effective 3 March 2020 (word version)

2020 Mining Proposal Checklist - 1050 Kb

Checklist to assist with the preparation of a mining proposal

ProForma - Mining Closure Plan for Small Mining Operations - March 2020 - 201 Kb

Proforma to be used for reviewed Mine Closure Plans - as per the Statutory Guidelines for Mine Closure Plans - effective 3 March 2020 (pdf version)

ProForma - Mining Proposal for Small Mining Operations including Mine Closure Plan - March 2020 - 446 Kb

ProForma as per the Statutory Guidelines for Mining Proposals and Statutory Guidelines for Mine Closure Plans – effective 3 March 2020 (pdf version)

Sterilisation report submission form for In-pit waste/tailings disposal proposals - 327 Kb

Sterilisation report submission form for In-pit waste/tailings disposal proposals

Mining Proposal Scoping Document - 1057 Kb

Mining Proposal Scoping Document

Mine Closure Plan Checklist - 1047 Kb

Checklist to assist with the preparation of a mine closure plan.

Proforma for Notification of Minor Changes to a Mining Proposal - 1045 Kb

Proforma for notification of minor changes to a mining proposal.

Environment Group Site Details and Activity Details Form - 1057 Kb

Environmental group site details and activity details form

Programme of Work - Prospecting (PoW-P) Application Form - 414 Kb

Download PDF version of the PoW-P application

Programme of Work Rehabilitation Report - 360 Kb

On completion of a Programme of Work, a Programme of Work Rehabilitation Report should be completed and submitted

Environmental & Reportable Incident/Non-compliance Reporting Form - 64 Kb

Operators are required to submit this report after the reportable incident notification.

Excess Tonnage Request - 162 Kb

Application for excess tonnage

Need more info, access the ‘How Do I' pages which provide detailed information on all applications, notifications and reports.