.Incident Date: _________________ ......Time: _________________

Location (specify):. ___________________________________________
............. Weather: ____________________________________________
Name of Vessel that caused the incident:.____________________________
.Other Vessel(s) present at the time:._______________________________
.............................How long were you at the scene:___________________

Which species of whale did you see and indicate the number you saw of each:

Species:______________.... Number:______________
Species:______________.... Number:______________

Describe as closely as possible the activity of the whales
before, during and after the incident:
___________________________________________________________________
___________________________________________________________________

Name of witness(es), if applicable:_______________________________________

.......... Your name:______________________________________
............... Address:______________________________________
Telephone (home):__________________
Telephone (work):__________________
E-Mail address:...._______ @ _____________________

Please PRINT and pass along to your local fishery officer -or- PRINT and mail to:
Marine Mammal Co-Ordinator
Species at Risk Office
Department of Fisheries and Oceans
Bedford Institute of Oceanography
P.O. Box 1006
Dartmouth, NS, Canada,
B2Y 4A2

For additional information: call (902) 426-6947

Definition of harassment - "to worry, trouble, or torment;
to trouble by repeated raids or attacks".