Telephone: Mobile: Address:

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1 Organisers Details Name of Event: Public Event Application Form (Public Event Approvals required for 50 persons or above) Application must be lodged to Town of Kwinana (TOK) Environmental Health Services at least 2 months before the event Event Organiser/ Applicant: Company/ Organisation: Postal Address: Telephone: Mobile: Fax: Address: Have you conducted this event before and if yes provide details: Contact Person (if different from event organiser/ applicant): Telephone: Mobile: Address: Event Details Date of event: Set up date & time: Event start date & time: Event finish date & time: Clean up date & time: Please submit an event timeline detailing all event activities to TOK Environmental Health Services 10 working days before the event. Venue (name of reserve, building or public open space): Event description (e.g. sporting, educational, entertainment): If the proposed venue is in a reserve, public open space or any building which has not been approved as a public building, please ensure that you complete: - an application to construct, extend or alter a public building (Form 1) and - an application for certificate of approval (Form 2). Applications are to be made to TOK Environmental Health Services 60 working days before the event. 1

2 Attendance Maximum number of people at any given time: Estimated attendance over the entire event: Target audience (e.g. youth, family): Is there disable access: A risk management plan is required for medium and high-risk events and/ or under request by TOK Environmental Health Services. Please submit the plan 60 days before the event. Insurance Will the event be covered by public liability insurance? Please ensure that you complete: - a trading in public places application form and - provide a copy of a current certificate of currency (ensure that public liability insurance of at least $10 million is arranged by the applicant) if Town of Kwinana is not the event organizer Application is to be made to TOK Environmental Health Services 14 working days before the event. Toilets Proposed temporary or portable toilets: Type Male WC Male Urinal Male Hand Basin Number Female WC Female Hand Basin Disabled toilet Permanent toilets (existing on the event ground): Type Male WC Male Urinal Male Hand Basin Number Female WC Female Hand Basin Disabled toilet Please ensure that there is an adequate supply of toilet paper and liquid soap prior to the event. Permits Will alcohol be served and/ or consumed? served / consumed / both/ no If consumption is at Town of Kwinana Facility, please complete application to consume alcohol at Town of Kwinana Facility. Application is to be made to Town of Kwinana Administration Reception 14 working days before the event. Will alcohol be sold at the event? If yes, a permit to sell, serve or supply alcohol is required from Dept of Racing, Gaming and Liquor (DRGL). Please attach copy of license. Application is to be made to DRGL 60 days before the event. Will fireworks, pyrotechnics, laser approval be required? If yes, complete an application for fireworks event permit by Dept of Mines, Petroleum and Resources Safety and attached a scaled site plan illustrating fall out or exclusion zone and fireworks shell used. Application is to be made to TOK Environmental Health Services 60 days before the event. Will an exemption for noise regulations be required? If yes, complete approval for a non-complying event with a scaled site plan illustrating the location of the sound desk, the location of the speakers and direction the speakers are facing. Application is to be made to TOK Environmental Health Services 60 days before the event. 2

3 First Aid Number of first aid attendants: Organisation providing first aid attendants: Name of first aid attendants: Number and location of first aid post: Will the first aid attendants be present throughout the entire event? A medical plan is required for large and high-risk events and/ or under request by TOK Environmental Health Services. Please submit the plan 60 days before the event. Waste Management Please submit a request for Waste & Recycling Service for Special Events. Application is to be made to TOK Environmental Health Administration Officer 10 working days before the event. Number of bins and type: Recycling Green waste Skip bins Other (please specify: ) Temporary Structures Any marquees, tents or any other temporary structures: yes / no If yes, please provide details of type and size (measurements and area m 2 ) Please indicate the time the person/ supplier will arrive to erect the temporary structure am/pm Persons details: Name Mobile Supplier details: Company Phone Any temporary staging: yes / no If yes, please provide details of type and size (measurements and area m 2 ) Please indicate the time the person/ supplier will arrive to erect the temporary stage am/pm Persons details: Name Mobile Supplier details: Company Phone For any temporary structures or stage>55m 2 in area, please obtain engineers or structural certification from supplier and a copy of a current certificate of currency (ensure that public liability insurance of at least $10 million is arranged by the applicant). Complete a marquee check list and certificate of temporary structure on the day of the event. 3

4 Animals Are animals likely to be present at the event? If yes, Will handwashing facilties be provided? Will alcohol based sanitisers be provided? Numbers and locations of sanitisers _ Will there be any petting zoo(s) at the event? Petting zoos include animal nurseries, mobile farms, animal show/ exhibits. Please indicate the type of petting zoos which will be present at the event. Signages are required to direct visitors of the locations of handwash facilities and sanitisers in accordance with the petting zoo guidelines. Should there be any petting zoos at the event, Environmental Health Services will provide the organiser with a number of these signages prior to the event. Potable water supply Is free potable water available at the event: How many litres of potable water will be provided? yes/no Litres Company providing potable water Type of water: scheme/ spring/ other (please specify: ) Details of Food Stalls & Vehicles (Provide details of operator, contact number & type of food) Licensee/ Operator (Full Name) Company/ Organisation Contact Number Type of Food/ Drinks Each food stall or vehicle is required to: - complete a trading in public places application for temporary or mobile food business with existing notification or registration - provide a copy of a current certificate of currency (ensure that public liability insurance of at least $10 million is arranged by the applicant) and - provide a copy of verification of notification/ registration certificate for the temporary or mobile food business (unless notified/ registered with Town of Kwinana). Application is to be made to TOK Environmental Health Services 14 working days before the event. Please provide a copy of the handout - requirements for Temporary Food Stalls to the food stall or vehicle. All food stalls and vehicles may be inspected by an Environmental Health Officer prior to the event to ensure that it complies with the Australian and New Zealand Food Standards Code. 4

5 Details of Stallholders (sale of any goods, wares, merchandise, service provision) (Provide details of operator, contact number & type of products, service or activity) Licensee/ Operator (Full Name) Company/ Organisation Contact Number Product/ Service/ Activity Each stallholder is required to: - complete a trading in public places application form (non-food related), - provide a copy of a current certificate of currency (ensure that public liability insurance of at least $10 million is arranged by the applicant) and - ensure that any amusement rides are to comply with AS 3553 and provide log book with records of inspections and maintenance during the event. Please note that amusement rides, performers, entertainers and service providers (including community and charitable groups) are required to provide the details mentioned above. Application is to be made to TOK Environmental Health Services 14 working days before the event. Are any community and charitable groups covered by the Town of Kwinana public liability insurance? If yes, please specify the groups which are covered Utilities Type of communication systems available: PA systems/ other (please specify: ) Power sources: Generator / LPG / other (please specify: ) Specify the numbers and location of each power source: Licensed electrician required and present on the day of the event: If yes, please indicate the time the electrician will arrive am/ pm Electrician s contact details: Name Mobile Company Phone Should power sources be present, please have a licensed electrician to be present on the day to sign off on Certificate of electrical compliance (Form 5). Large generators and electrical cables are to be protected from the public access. 5

6 Crowd Controllers Numbers of security officers : Company providing security officers: Numbers of crowd controllers: Company providing crowd controllers: Area of patrol and any permanent position of security officers and crowd controllers Please provide a copy of a current certificate of currency (ensure that public liability insurance is arranged for of at least $10 million). A crowd control plan is required for high-risk events and/ or under request by TOK Environmental Health Services. Please submit the plan 60 days before the event. Transport and Parking arrangements Will traffic controllers be available? Numbers of traffic controllers: Company providing traffic controllers: Is there sufficient off road parking available? yes/no yes/no Is road access and egress adequate to allow for access by emergency services? yes/no Details of any road closures or use of roads for the event Post event transport (e.g. availability of taxis, buses etc) Emergency Services Are the following emergency services notified or present at the event? Police Fire brigade St John Ambulance Other (Please specify ) notified only / will be present notified only / will be present notified only / will be present notified only / will be present An emergency management plan is required for medium and high-risk events and/ or under request by TOK Environmental Health Services. Please submit the plan 60 days before the event. Other Are surrounding neighbours/ residents notified of the event? How are the surrounding neighbours/ residents notified? Please attach a copy of the notification letter to be sent to surrounding neighbours/ residents. Commencement date of advertising Neighbours are to be notified 7 days before the event. 6

7 Health promotion and publicity details: Sun protection/ SunSmart Safe and responsible drinking practices Smoke free environment Drug free event Other health care advice Anticipated weather (rain, wind, heat, cold) / NA / NA / NA / NA Additional comments Please be aware once the initial application has been assessed by Environmental Health Services further information may be required from the applicant. Acknowledgement I, as the event organiser, seeking approval to host an event acknowledge that the information and completed actions in my application are true and correct. I will ensure that appropriate liability and other insurances are in place for the activities to be conducted. I understand that the Event Application Form is a guide and has been complied according form and that as the event organiser I am responsible. Signature: Date: Town of Kwinana Environmental Health Officers can assist you with the application form. Telephone: Fax: [email protected] 7

8 Please check that the following documents are supplied prior to the event in order to obtain health approvals Check Event application form Event site plan Event site plan needs to indicate the locations of the following: - First aid post - Generators and electrical cables - All stallholders - Fenced off areas and signages - All food stalls and vehicles - Lighting - Emergency services - Portable water outlet - Temporary structures including marquees - Public and staff parking and staging - Toilets - Sound desk and speakers - Emergency access Risk management plan Evacuation plan.. Crowd control plan. Medical plan... Trading in public places application (to be completed by various stallholders) Trading in public places application (to be completed by event organiser) Application for single event or annual event temporary or mobile food business..... Application to construct, extend or alter a public building Form Application for certificate of approval Form 2 Copies of certificate of currency attached. (Check expiry date and that the Public liability insurance cover is of at least $10 million) Noise non-complying event application with scaled site plan.. Noise management plan.. Notification letter (letter sent to surrounding neighbours/ residents). Fireworks/ pyrotechnics/ laser approval with scaled site plan Request for Waste & Recycling service for special events... Alcohol consumption permit at TOK facility attached Copy of permit to sell, serve or supply alcohol is required from Dept of Liquor Licensing. Obtain signages from environmental health services (animals/ petting zoos).. Sanitisers purchased. The following are to be completed on the day of the event: Certificate of electrical compliance Form Certificate of temporary structure.... Marquee checklist... Check log book of amusement rides.. Inspection of all food stalls and vehicles 8