Dust complaint form

Dust complaint form
Complainant details
Name*

First nameLast name
Organisation (if applicable)
Address

Street address

Street address line 2

SuburbState

Post code
Phone number
Mobile
Please enter a valid phone number.
Email*
example@example.com
Details of the dust event
Date the event started

DayMonthYear
Date (estimated if not witnessed)
Date the event finished

DayMonthYear
Date
Please advise additional information (if you think you know):
Period of the day

MorningAfternoonDuring the dayNight
If you know the prevailing wind direction during this period
Location
Please indicate where you observed the dust fallout / deposition
Type of dust
Colour

BlackDarkGreyRedYellowWhiteOther
How the dust looks

CourseFine
Other observations
Deposition density
How much dust (see key below)
Dust density guide

Low density: Dust particles covered less than 20% of the surface

Medium density: Dust particles covered 20 to 50% of the surface area

High density: Dust particles covered more than 50% of the surface area

The following diagrams are a general guide to assist in determining how much dust fallout has occurred.
Dust source
If you think you know, please state where you think the dust was emitted from.
Impact on your household or family
Did the dust disrupt your activity? If yes, what did you have to change?
Health effect
If you experience health effects, please provide details. How did the odour make you feel? How long did you feel this?
Additional comments
Upload photos

When uploading your documents please note the max file size is 1GB and we have restrictions on the types of files you can upload. If you are unable to upload your file, please forward to us at pollutionwatch@dwer.wa.gov.au
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Dust complaint form

Complainant details

Details of the dust event

Please advise additional information (if you think you know):

Type of dust