PUBLIC EVENT APPROVAL APPLICATION

This form is to be used for the purposes of satisfying the requirements, under the Health Act 1911 and to obtain approval for a public event. All fields must be completed. If a particular field is not relevant, please mark as ‘not applicable’.

Have you read our Public Events Guide? It will make completing this application much easier. Please contact the City of Swan for a copy on 9267 9356 or events@swan.wa.gov.au

1878-3

EVENT DETAILSEvent name

Event location (Name and address)

Is the event on City owned land? Yes No Tentative booking number

Event dates Event time

Set up date/s Start and finish times

Pack up date/s Start and finish times

Event description

Event program and site plan (Please attach site plan - your application can not be approved without it.)

EVENT ORGANISERS DETAILSOrganisation name

Is the organisation a charity or not for profit community group? Yes No

Contact person

Postal address

Phone Mobile

Email

Contact person during the event

Name

Mobile

EVENT SPECIFICSWill this event be open to the general public? Yes No

Will this event be invitation only? Yes No

Is there an entry fee? Yes No

What are the ticket prices?

Overall expected numbers

Maximum expected numbers at any one time

Will security/crowd controllers be present? Yes No If yes, how many?

Name of company supplying security/crowd controllers

TRAFFIC AND PARKINGPlease detail the parking arrangements here, location, type (bitumised car park or grassed area) parking attendants, shuttle buses etc.

Will you require any road closures for this event? Yes No

If yes you will require a traffic management plan, is this attached? Yes No

Have you enclosed a copy of your written request to Main Roads or WA Police? Yes No

Have you enclosed your written request to City of Swan? Yes No

STRUCTURES AND FACILITIESWhere the event is being held on City-owned land, will the event be using any existing structures or facilities?

Yes No

Please detail

Will there be any temporary structures used at the event (stages, marquees, bouncy castles etc.)

Yes No

Please detail and include providers name

POWERWill your event require power? Yes No

How will your requirements be met? Existing fixed outlets Portable generator needed?

TOILETSWill you be using existing toilet facilities? Yes No

Will you be using temporary toilet facilities? Yes No

How many will this total

MALE WC Hand Basin Urinals (number or in metres)

FEMALE WC Hand Basin

DISABLED WC Hand Basin

FOODWill you have mobile food vendors? Yes No

Is your Street Traders application attached? Yes No (for City owned or controlled land only)

WASTEWill you require extra bins from the City? Yes No

Please contact Waste Services on 9267 9267 to book bins and arrange payment.

RISK & EMERGENCY PROCEDURESWill there be alcohol at this event? Yes No

Please select BYO SUPPLIED SOLD

If supplied or sold you will need approval from Racing, Gaming & Liquor; have you lodged an application? Yes No

Have you completed a risk assessment for your event? Yes No

If you are expecting more than 1000 patrons; have you enclosed your Risk Management Plan? Yes No

Do you have an Evacuation Plan in place? Yes No

Is there clear access for emergency vehicles? Yes No

Do you have First Aid in place? Yes No

Who is supplying this service

Number of first aid posts

Number of first aiders

In case of fire, what equipment is at hand? (Number and type of extinguishers, reels, water tanks)

Do you wish to have fireworks at this event? Yes No

Have you notified surrounding residents? Yes No

Have you enclosed your approval from the Department of Mines and Petroluem? Yes No

Have you notified emergency services?

Police Yes No

FESA Yes No

St John’s Ambulance Yes No

If your event is on City land, do you have a minimum of $20 million in Public Liability Insurance? Yes No

Have you attached a copy of the Certificate of Currency to this application? Yes No

MUSICWill your event have music Yes No

Acoustic or Amplified

Please detail

Have you notified residents Yes No

Have you attached your REG 18 form Yes No

LODGING YOUR APPLICATIONOnce completed please return to the City of Swan

In person City of Swan Administration Centre, 2 Midland Square, Midland By mail PO Box 196, Midland WA 6936 By email events@swan.wa.gov.au By fax 9267 9444

FEES AND CHARGESSome fees and charges may be applicable depending on the specific situation and you will be notified by Health Services to make payment where applicable.

For more information on fees please refer to the Public Events Guide.

FURTHER ADVICE AND ASSISTANCEShould you have any questions regarding any of the above, please do not hesitate to contact the City of Swan on 9267 9356 or email events@swan.wa.gov.au.

DECLARATIONI declare that the above information is correct to the best of my knowledge.

Signature Name

Date