Dam Information Form
Dams Safety NSW - Dam Information form
The purpose of this form is to collect information about the declared dam and its owner/s, enabling Dams Safety NSW to maintain accurate and up to date records.
Section 1 - Details of the declared dam
Name of declared dam
Location of dam
Elevation of crest
Elevation of FSL
Latitude
Longitude
River / Stream
Catchment area
Dam height
Storage volume (ML)
Description of material stored in the dam (eg. fresh water, saline water, stormwater, coal ash, coal fines, metal mine tailings)
Materials
Purpose of the dam
Please select...
Environmental controls (eg. tailings storage facility that impounds contents)
Flood control (eg. retarding basin)
Hydro-electricity
Recreation
Stormwater bioretention basin
Water supply (eg. town water, stock and domestic, irrigation)
Other (please specify)
Purpose of dam (if 'Other' selected)
Type of dam
Please select...
Concrete arch
Concrete buttress
Concrete gravity
Decked rockfill
Earthfill
Masonry buttress
Rockfill
Section 2 - Design flood assessment
Inflow flood peak (m3/s)
Annual exceedance probability
Method
Date of assessment
Main spillway type
Please select...
Chute
Fuse plug
Gated
Labyrinth
Shaft
Side channel
Stepped
Other
Spillway type (if 'Other' selected)
Sunny day consequence category (determined by competent person - refer to '
Declared dams consequence category assessment and determination methodology
')
Sunny day assessment
Extreme
High A
High B
High C
Significant
Low
Very low
Reason for Sunny Day assessment (including PLL or PAR
Flood consequence category (determined by competent person - refer to '
Declared dams consequence category assessment and determination methodology
')
Flood consequence assessment
Extreme
High A
High B
High C
Significant
Low
Very low
Reason for Flood consequence category assessment (including PLL or PAR
Is there a possibility of cascading to downstream dams
No
Yes
Names and river distance to downstream dams
Names and river distance to downstream dams
Section 3 - Design and construction (existing dams only)
Designed by
Constructed by
Year of completion
Frequency of surveillance inspections
Date of Dams Safety Management System document
Date of Dam Operations and Maintenance Plan
Date of Dam Emergency Plan
NOTE - email design and construction reports and the current dam emergency plan to
info@damsafety.nsw.gov.au
Section 4 - Dam owner's details
Dam owner /Organisation
(person or public authority who, whether solely or with some other person or public authority, owns, controls, operates, manages or maintains the Dam, or proposed dam)
x
ABN
This information will be used for the dam safety levy and must correspond to the ABN of registered dam owner. If ABN unknown put 00000
x
Owner phone number
Email of dam owner
(person or public authority who, whether solely or with some other person or public authority, owns, controls, operates, manages or maintains the Dam, or proposed dam)
x
Owner / organisation address for official correspondence from DSNS
(person or public authority who, whether solely or with some other person or public authority, owns, controls, operates, manages or maintains the Dam, or proposed dam)
x
Section 5 - Contact person for the dam (
Dams Safety Regulation Clause 24A
)
The 24A contact person for the dam is nominated by the owner or involved in the business and reasonably available to be contacted by DSNSW.
Dams Safety NSW must be notified within 14 days if this contact changes.
First name of 24A contact
Name of 24A contact
Position of 24A contact person
Phone number of 24A contact
Email for 24A contact person
Mailing address of 24A contact
City
State
Postcode
Second 24A contact
Nominate a second 24A contact for the dam
First name of additional 24A contact
Last name of additional 24A contact
Position of additional 24A contact person
Phone number of additional 24A contact
Email of additional 24A contact person
Section 6 - Person completing form
First name of person completing form
Last name of person completing form
Position of person completing form
Email of person completing form
Phone number of person completing form
Please read the
Privacy Statement
to how Dams Safety NSW manages your personal information.
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