Adelaide Hills Council Event Application Form

Transcription

1 Adelaide Hills Council Event Application Form TRIM: IC.... /. 1. Applicant Details (If more than one organisation is involved in the management of this event please request an additional form for Applicant Details) Organisation: DEPARTMENT ACTION Description of Organisation: Postal Responsible Person & Title: Contact details: (home) (work) (mobile) (event mobile) Container No... Fax) (www) ( ) Acc No Event Details Event Event Date(s): Event Day(s): Event Times: (start) (finish) (total hours) No of days to Bump In: Date(s) & Time: No of days to Bump Out: Date(s) & Time: DEPARTMENT ACTION Event Schedule - AHT Website.. Public Consultation?.. D.T.E.I. Road? Y / N Site Available.. Ins. Copy.Y/N Proposed Location: Event Type: Date Booked Assess No... Keys required : Entry Fees : $ AHT site.. Attendance Profile & Expected Numbers at Event: Council Report Required? 3. Will First Aid be available at your event? If No, please give details as to why First Aid is not needed at your event. Please note: most events will require a First Aid presence. If Yes, please supply provider s details. Page 1

2 4. Will your event include any Public Communications? If yes, please include details of : 2Ways, Mobiles, PA System 5. Will your event include any Lighting and Power? If yes, please give details. Note: All appliances must have a current tested tag. ALL power cords crossing an access, footpath or road must be covered by a ramp. 6. Will your event require assistance with advertising? If yes, please provide:- At least 8 posters for community noticeboards. Flyers for Council distribution. At least 4 months notice for inclusion in the Hills Voice Newsletter. 7. Have you advised the Emergency Services Departments? SA Police CFS Ambulance 8. Will you have qualified security personnel in attendance at your event? Please give details as to why security personnel are not required OR of the security personnel arrangements. 9. Will your event include temporary structures such as portable stages, marquees, amusement rides or other constructions? If yes, please provide details including dimensions, structural details etc.* For amusement rides accreditation is required along with a copy of current Public Liability Insurance. It is required by Adelaide Hills Council that SafeWork SA be notified about events using Staging & Rigging structures over 1 mtr high. Refer Event Safety Management flyers You must attach current Safework SA Registration Certificate It is the responsibility of the Event Organiser to ensure compliance of South Australian accreditation serial numbers on both the accreditation paperwork and the amusement ride being used at the event. *Please note if development approval is required assessment for both Planning and Building may take up to 16 weeks. Page 2

3 10. Have you considered any disabled requirements? If yes, please provide details of requirements, management procedures. (Blind, deaf, physically impaired etc.) 11. Will you be using Volunteers at your event? If yes, please provide details of volunteer roles, insurance, management procedures, training, induction and compliance with the Volunteer Protection Act SA Will you be having activities for children or providing crèche facilities? If yes, please provide evidence that staff and/or volunteers involved in these activities/facilities have undergone the necessary accreditation and police checks. 13. Have you advised all surrounding residents and commercial properties of the event? (Noise, traffic, music etc.) If yes, please advise by which means this was done. 14. Will your event include amplified music or speeches? If yes, please provide details including what will be amplified, and times. The Environmental Health Officers can supply guidelines. Will you require an APRA Licence Will food be served at your event? If yes, our Environmental Health Officer will contact you. All Groups/Businesses supplying food must be listed, for the Health Officers to be able to contact. Please provide general details and complete the following table: Fire extinguishers or appropriate means of fire control supplied by each business? Food storage arrangements supplied by each business/group/stall? Hand-washing facilities supplied by each business/group/stall? Page 3

4 Type of food Facilities required/utilised Supplier/Caterer Contact Details If you have additional stalls/caterers please attach a further page. 16. Will you be supplying additional toilets/blocks for your event? If yes, you will need to assess the required numbers. If the event has an approved liquor license, additional toilet requirements as stated in the license must be complied with. Portables Blocks Plumber. Electrician. 17. Will your event include animals for display or handling? If yes, please provide details regarding type of animals, purpose, management, containment, waste disposal and hand-washing facilities. The Environmental Health Officer will arrange an event inspection. Page 4

5 18. Personal Protective Equipment All event staff Voluntary or Permanent MUST be supplied personal protective equipment in relation to the event. Sunhat Sunblock Sunglasses Drinking water Safety jackets (e.g. for traffic control) Be wearing fully covering clothing 19. Will alcohol be served at your event? If yes, a Liquor License will be required (Please note: Council requires a minimum of 6 weeks notice, written notification is to be forwarded to the Planning Department): DEPT PLANNING I/we have applied for a Liquor Licence. Date expected for approval: Liquor Licence approved. Please provide a copy to Council. 20. Will your event require road closures and/or part road closures? If yes, please provide details of road(s) to be closed, times and dates and Traffic Management Plan showing diversions and detours around the site. The traffic management must be completed and authorised by a person who is accredited in traffic management (including bump in/out times), congregation and disbursement areas for people and vehicles and estimated number of people and vehicles participating. Council requires 8 weeks notice before an event. DEPT ENGINEERING Advertising will be organised by whom? If signage required longer than 1 day what arrangements are made to care for them? Do your personnel hold a current Workzone Traffic Management Certification? Please Supply a Traffic Management Plan showing signage WITH THIS APPLICATION Traffic Control Company? If a Department for Transport Energy and Infrastructure road is to be closed you are required to supply a copy of a Traffic Management Permit to Council. Bus companies must be supplied maps and road lists. Advise Works of roads being used list and maps. Page 5

6 20.A Will your event require road restrictions? If yes, please provide details of road(s) to be affected, times and dates (including bump in/out times), congregation and disbursement areas for people and vehicles and estimated number of people and vehicles participating. A map of the area and what signs are required. DEPT ENGINEERING Note: Council requires 8 weeks notice before an event. 21. Will your event require additional waste management? If Yes, please provide details. Council may be able to assist with the supply of Community Bins. DEPT WORKS Number of bins Extra rubbish collection 22. Will your event require pegging of any lawns, on Council property? If Yes, please provide details, Council will arrange a pre-event site inspection with a staff member from Parks & Gardens to identify all underground services Number of bins DEPT WORKS 23. Will your event require mowing of any lawns, on Council property? DEPT WORKS NOTE : All Council lawns, parks, gardens and reserves are for Non-exclusive Use. 24. Will your event include any fireworks or other pyrotechnics? Technician: If yes, please include details of:- The licensed technician approved by SafeWork SA to carry out a fireworks display. You will need to provide:- A copy of the technician s pyrotechnics licences that conforms to the 2001 regulations and conditions of the Australian Explosives Act An approved SafeWork SA application to have a fireworks display. DEPT FIRE PREVENTION Company: Telephone: Mobile: Page 6

7 25. Will your event require any comfort fires? If yes, please include details :- (A permit is required within the Total Fireban dates.) DEPT FIRE PREVENTION 25.A Will your event require a Fire Permit for a BBQ? If yes, please include details :- (A permit is required within the Total Fireban dates.) A fire extinguisher is required to be available during these dates. DEPT FIRE PREVENTION 26. Will your event require temporary signage? By Laws apply to temporary signage for events. Signage on private land requires development approval (min 8 weeks notice required) Please supply layout. DEPT GEN INSPECTORS Note: Banners on Council Property require booking. 27. Will your event create the need for extra Public Transport? OR will it effect the current public transport system? Where public transport is required or effected, liaison should be made with LinkSA ( ) or through the Traffic Management Officer. DEPT GEN INSPECTORS 27.A Will your event create the need for A Roadside Trading Permit? Where any part of an event is held on any footpath/road it requires a permit. DEPT REG SERVICES Page 7

8 Note: SPECIAL CONDITIONS WILL BE ATTACHED FOR 28 & Activities contained within Adelaide Hills Council By-Laws Applicable to Events: Camping Trading Preaching Animals Fireworks Posting of Bills Donations Overhanging Displays Entertainers Amplification Other: 29. Activities contained within Adelaide Hills Council Policies Applicable to Events: Public Consultation Banners Over Roadways Liquor Booths Parklands, Approval of Use Other: 30. Public Liability Insurance a Copy of a Policy or a Cover Note for $20,000,000 must be attached: is it attached Y / N or date to be supplied.. /.../... All other parties involved in the event are to provide an appropriate Certificate of Currency for their Public Liability Ins, to be retained by the Event Manager. 31. Risk Assessment, Emergency Response Plan, Event Management Plan, Insurance For your event to be approved you will be required to supply copies of your: Risk Assessment Plan Emergency Response Plan. Event Management Plan. Public Liability Insurance - $20,000,000 Risk Assessment Plan Emergency Response Plan Event Management Plan Public Liability Insurance I,, acknowledge the Event Application Form submitted is subject to the consideration and approval of authorised Officers of Adelaide Hills Council. I authorise for the information contained in the event application form and attached to the event application form to be circulated and reviewed by Adelaide Hills Council Officers and their advisers. I acknowledge that it is the responsibility of the Event Organiser to ensure that the event meets all necessary by-law, policy, standards and legislative requirements. I am aware that the Event Application will be considered in accordance with the information provided on this application form, event management plan and the relevant attached documents and will not be valid until appropriate Public Liability Insurance cover, of $20,000, has been confirmed- a copy of a current Insurance Policy or Cover Note. The Event organiser agrees to indemnify and to keep indemnified the Council, its servants and agents and each of them from and against all actions, costs, claims, damages, charges and expenses whatsoever which may be brought or made claimed against them or any of them arising out of or in relation to the issuing of the permit. Any undisclosed alterations to the said event or noncompliance with the general and special conditions of the permit, once issued, may result in the permit being revoked pursuant to section 225 of the Local Government Act SA (1999). Applicant: Signed: Date: Council Officer: Signed: Date: IMPORTANT: Any personal information provided by you on this form will be used by Council or its agents to process this application. The provision of this information is voluntary, however if you do not provide the information Council will be unable to process your application. Once collected by Council, the information can be accessed by you and may also be available to 3rd parties in accordance with the Freedom of Information Act SA (1991). www. ahc.sa.gov.au Fax Phone [email protected] - to lodge this application OR Adelaide Hills Council, PO Box 44, Woodside SA 5244 Page 8