Forms
Schedule 1 Forms
[r. 3]
No. | Form | Section of Act | ||||
1 | Warrant | 13, 14, 17, 19 and 22 | ||||
2 | Application for emergency authorisation | 21 | ||||
3 | Emergency authorisation | 21 | ||||
4 | Application for — • tracking device warrant • tracking device (maintenance/retrieval) warrant | 15 and 19 | ||||
Surveillance Devices Act 1998, s. 13, 14, 17, 19 and 22 Warrant | Supreme Court judge Magistrate At......................................... | |||||
Strike out any parts of this form that are not applicable | ||||||
Person to whom warrant is issued | Name | |||||
Member of police force Officer of the Corruption and Crime Commission Officer of a designated Commission Member of staff of Australian Crime Commission | ||||||
Warrant issued on behalf of another law enforcement officer | ||||||
Person, object or premises under surveillance | Person______________________________________________ Unknown person ____________________________________ Object______________________________________________ Premises____________________________________________ | |||||
Offence | Offence_________________________________________________ Act or Regulations _______________________________________ Section or regulation no. | |||||
Authority to use surveillance device | This warrant authorises you — to attach or install, use, maintain and retrieve a — listening device optical surveillance device tracking device in relation to a tracking device attached to, or installed in, a vehicle, to — maintain the device retrieve the device maintain and retrieve the device to retrieve a — listening device optical surveillance device tracking device attached or installed under an emergency authorisation | |||||
The surveillance device may be attached or installed, used or maintained — in, on or at the premises under surveillance in or on the object under surveillance in respect of the private conversations, private activities or geographical location of the person under surveillance, at premises where the person is reasonably believed to be or is likely to be | ||||||
Where practicable the surveillance device should be retrieved or rendered inoperable during the period that the warrant is in force | ||||||
Authority to enter premises | This warrant authorises you to enter, by force if necessary — (specified premises) __________________________________ _____________________________________________________ any premises where the object or person under surveillance is reasonably believed to be or is likely to be and any premises adjoining or providing access to those premises any premises where the vehicle on or in which the device is attached or installed may for the time being be any premises where the surveillance device to be retrieved may for the time being be | |||||
Authority to use electricity supply | This warrant authorises you to connect the surveillance device to an electricity supply system and to use electricity from that system to operate the device | |||||
Authority to remove vehicle | This warrant authorises you to temporarily remove this vehicle from this premises for the purpose of — attaching installing maintaining retrieving a tracking device | |||||
Vehicle | ||||||
Premises_____________________________________________________ | ||||||
You must return the vehicle to the premises when the device has been attached, installed, maintained or retrieved | ||||||
Period of warrant | ___/___/______ to ___/___/______, being ___________________days | |||||
The warrant may be used at any time of the day or night | ||||||
Conditions | This warrant is subject to these conditions | |||||
Issue of warrant | Signature Judge / Magistrate Date Time | |||||
[Form amended: Act No. 74 of 2004 s. 73(3); Gazette 5 May 2006 p. 1736; 21 Sep 2007 p. 4735.]
Surveillance Devices Act 1998, s. 21 Application for emergency authorisation | |||
Strike out any parts of this form that are not applicable | |||
Applicant | Name | ||
Business address | |||
Postcode | |||
Phone no. | |||
Member of police force Officer of the Corruption and Crime Commission Officer of a designated Commission Member of staff of Australian Crime Commission | |||
Person, object or premises under surveillance | Person______________________________________________ Unknown person Object______________________________________________ Premises____________________________________________ | ||
Action for which authorisation | Authorisation is required to — attach or install use maintain a listening device to record, monitor, or listen to a private conversation an optical surveillance device to record visually or observe a private activity a tracking device to determine the geographical location of a person or object in relation to the — premises under surveillance object under surveillance person under surveillance retrieve — a listening device an optical surveillance device a tracking device | ||
Grounds | Imminent threat |
Threat of serious violence to a person Name______________________________________________ Threat of substantial damage to property Description | |
Grounds cont. | Offence |
Indictable drug offence Relevant section of Misuse of Drugs Act 1981 — 6(1) 7(1) 33(1)(a) 33(2)(a) External indictable drug offence External law ________________________________________ Corresponding section of Misuse of Drugs Act 1981 — 6(1) 7(1) 33(1)(a) 33(2)(a) Offence punishable by 2 or more years imprisonment Offence_____________________________________________ Relevant Act_________________________________________ section | |
The offence — has been committed may have been committed is being committed is about to be committed is likely to be committed Date offence committed or expected to be committed | |
The use of the surveillance device is immediately necessary for the purpose of — dealing with the threat investigating the offence enabling evidence to be obtained of — the commission of the offence the identity of the offender the location of the offender | |
These factors make the circumstances serious___________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ These factors make the matter urgent _________________________ _______________________________________________________ _______________________________________________________ | |
Reasons an application under section 15 or 16 for a warrant is not practicable ______________________________________________ _______________________________________________________ | |
Retrieval to avoid jeopardizing investigation of drug offence | |
Indictable drug offence Relevant section of Misuse of Drugs Act 1981 — 6(1) 7(1) 33(1)(a) 33(2)(a) | |
Grounds cont. | External indictable drug offence External law: __________________________________________ Corresponding section of Misuse of Drugs Act 1981 — 6(1) 7(1) 33(1)(a) 33(2)(a) |
These factors make the circumstances serious____________________ __________________________________________________________ __________________________________________________________ These factors make the matter urgent___________________________ __________________________________________________________ | |
Reasons an application under section 22 for a warrant is not practicable_________________________________________________ | |
Entry to premises | Entry, by force if necessary, is required to — (specified premises) ________________________________ __________________________________________________ any premises where the object or person under surveillance is reasonably believed to be or is likely to be and any premises adjoining or providing access to those premises |
Use of electricity supply | Authorisation is required to connect the surveillance device to an electricity supply system and use electricity from that system to operate the device |
Removal of vehicle | Authorisation is required to temporarily remove a vehicle from a premises for the purpose of — attaching installing maintaining retrieving a tracking device |
Vehicle | |
Premises___________________________________________________ | |
Period of authorisation | Period for which authorisation is required __________________days Reason this period is required _______________________________ __________________________________________________________ |
Signature of applicant | Date |
[Form amended: Act No. 74 of 2004 s. 73(3); Gazette 5 May 2006 p. 1736; 21 Sep 2007 p. 4735.]
Surveillance Devices Act 1998, s. 21 Emergency authorisation | |||||
Strike out any parts of this form that are not applicable | |||||
Authorised person | Name | ||||
Commissioner of Police Deputy Commissioner of Police Assistant Commissioner of Police Officer of the Corruption and Crime Commission Officer of a designated Commission Person authorised by Chair of Board of Australian Crime | |||||
Person to whom authorisation is issued | Name | ||||
Member of the police force Officer of the Corruption and Crime Commission Officer of a designated Commission Member of staff of Australian Crime Commission | |||||
Person, object or premises under surveillance | Person_______________________________________________ Unknown person Object_______________________________________________ Premises_____________________________________________ | ||||
Authorisation to use surveillance device | This authorisation authorises you to — attach or install use maintain a listening device to record, monitor, or listen to a private conversation an optical surveillance device to record visually or observe a private activity a tracking device to determine the geographical location of a person or object in relation to the — premises under surveillance object under surveillance person under surveillance retrieve — a listening device an optical surveillance device a tracking device | ||||
Authority to enter premises | Entry, by force if necessary, is required to — (specified premises) __________________________________ ________________________________________________ any premises where the object or person under surveillance is reasonably believed to be or is likely to be and any premises adjoining or providing access to those premises |
Authority to use electricity supply | This authorisation authorises you to connect the surveillance device to an electricity supply system and to use electricity from that system to operate the device. |
Authority to remove vehicle | This authorisation authorises you to temporarily remove this vehicle from this premises for the purpose of — attaching installing maintaining retrieving a tracking device |
Vehicle | |
Premises_________________________________________________ | |
You must return the vehicle to the premises when the device has been attached, installed, maintained or retrieved | |
Period of authorisation | ___/___/______ to ___/___/______, being ______________days |
The authorisation may be used at any time of the day or night | |
Conditions | This authorisation is subject to these conditions |
Authorised person(s) | Signature Date Time |
Signature Date Time |
[Form amended: Act No. 74 of 2004 s. 73(3) and (4); Gazette 5 May 2006 p. 1736; 21 Sep 2007 p. 4735.]
Surveillance Devices Act 1998, s. 15 and 19
Application for —
• tracking device warrant
• tracking device (maintenance/retrieval) warrant
Strike out any parts of this form that are not applicable | |
Applicant | Name |
Business address | |
Postcode | |
Phone no. | |
Member of police force Officer of the Corruption and Crime Commission Officer of a designated Commission Member of staff of Australian Crime Commission | |
Application is made on behalf of another law enforcement officer (Name) | |
Person, object or premises under surveillance | Person (see note 1)_______________________________________________ Unknown person Object _____________________________________________ Premises____________________________________________ |
Nature of warrant | Tracking device warrant (s. 13) Tracking device (maintenance/retrieval) warrant (s. 14) to — maintain a tracking device retrieve a tracking device maintain and retrieve a tracking device |
New warrant Extension of current warrant | |
Period of warrant | Period for which warrant is required ______________________days Reason this period is required_______________________________ _______________________________________________________ |
Grounds | Tracking device warrant (s. 13) |
Offence | |
Act or Regulations | |
Section or regulation no. | |
The offence — has been committed may have been committed is being committed is about to be committed is likely to be committed Date offence committed or expected to be committed | |
The use of a surveillance device would be likely to — assist an investigation into the offence enable evidence to be obtained of — the commission of the offence the identity of the offender the location of the offender | |
Tracking device (maintenance/retrieval) warrant (s. 14) | |
Vehicle | |
Location when device installed______________________________ Current location | |
Person who installed device ________________________________ Member of police force Officer of the Corruption and Crime Commission Officer of a designated Commission Member of staff of Australian Crime Commission Member of prescribed class of persons Specify class ________________________________________ | |
Entry to premises | Entry, by force if necessary, is required to — (specified premises) __________________________________ _______________________________________________ any premises where the object or person under surveillance is reasonably believed to be or is likely to be and any premises adjoining or providing access to those premises any premises where the vehicle on or in which the device is attached or installed may for the time being be any premises where the surveillance device to be retrieved may for the time being be |
Use of electricity supply | Authority is required to connect the surveillance device to an electricity supply system and use electricity from that system to operate the device |
Removal of vehicle | Authority is required to temporarily remove a vehicle from a premises for the purpose of — attaching installing maintaining retrieving a tracking device |
Vehicle | |
Premises________________________________________________ | |
Signature of applicant | Date |
Note 1 — Identification of person under surveillance | |
The person under surveillance may be identified by a numerical reference identifying the relevant law enforcement agency and the year in which the application is made. For example —WAPS 1/1999 (for the first application in 1999 by a member of the WA police force) | |
Note 2 — Lodging of Application for warrant | |
The application is to be lodged with the magistrate. An application must be accompanied by — • an “Authorisation of surveillance”; and • an affidavit containing a “Statement of facts in support of application for warrant” in accordance with Surveillance Devices Act 1998, s. 15(3)(a), (b), (c) and (f). An application should also be accompanied by a draft warrant in the form of the warrant being sought. | |
[Form inserted: Gazette 8 Feb 2000 p. 458‑60; amended: Act No. 74 of 2004 s. 73(3); Gazette 5 May 2006 p. 1736; 21 Sep 2007 p. 4735.]
The statute text is free to read above. View subscription options to unlock the case-law research tools for each provision.