Visitor registration form

Visitors MUST complete and submit this form at least one day prior to their intended visit.

For large groups (e.g. shutdown crews) this completed form must be submitted a minimum of 48 hours prior to visit.

VISITOR DETAILS

Full name:

Date of birth:

Employer:

Phone number:

Email:

ID type:

ID number:

Upload photo or scan of ID:

Date of visit from:

To:

Vehicle registration:

Reason for visit:

ESCORT DETAILS

Note: Escort must be Pilbara Ports, Port of Ashburton inducted and hold a valid Pilbara Ports access card

Full name:

Employer:

Phone number:

Pilbara Ports access card number:

The 5-digit number on the back of the card

MSIC number:

Required if accessing any berths when the Land-side Restricted Zone is active

MSIC expiry:

Vehicle registration:

COVID-19 DECLARATION

All visitors to Pilbara Ports sites must complete this COVID-19 Declaration. Any visitor who refuses to complete the declaration or is unable to declare all of the questions will be refused entry to Pilbara Ports sites.

I declare that:

I am not diagnosed or suspected to have COVID-19 infection
I have not been in contact with someone that is a suspected (being tested) or confirmed case of COVID-19 in the past 14 days
In the last 14 days, I have not been in a jurisdiction that the State Government requires individuals to quarantine or isolate on arrival in WA
I do not currently feel unwell with any of the following symptoms:

Fever, fatigue or aches
Shortness of breath
Cold or flu like symptoms (such as a runny nose, cough or sore throat)

I declare

If you have any issues with this form, please call 08 9159 6529.

Notification will be sent to you confirming we have received this information.

Unless you are advised by Pilbara Ports Authority prior, this visitor and escort have conditional approval to enter the Port of Ashburton site within 24 hours.