Medium or High Impact Event Form

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Medium or High Impact Event Form
Please note,

If you are unsure which category your event fits into, please contact the Rural City of Wangaratta Events Team via

events@wangaratta.vic.gov.au or on 03 5722 0888.

Throughout this application at various sections you will find a notes, site plan or attachment required information box.

Please reference this information in order to ensure that you are providing all of the correct details on your application, site plan and attachments to be submitted with your application.
PART 1 - ABOUT YOUR EVENT
Organisation Name
Your name

Prefix
First Name
Last Name
Email
Your contact number

Your address

Street Address
Street Address 2
City	State / Province
Postal / ZipCode	Country

Are you a Community or not for profit organisation?*
This is a community or not for profit organisation.
This is a commercial organisation.
Event Name
Location of Event
Is this a road event? (e.g. a cycling event)
Yes
No
Roads being affected
Does your event access any unsealed roads?
Yes
No
Date and time of the event start
Month - Day - Year
Hour : Minutes
Date / time
Month - Day - Year
Hour : Minutes
Set-Up Time
Month - Day - Year
Hour : Minutes
Pack-Down Time
Month - Day - Year
Hour : Minutes
Estimated number of attendees throughout the duration of the event?
What is the MOST anticipated number of people at the event at any one time?
Description of your event
Is there entry to your event?
Free
Ticketed
Gold Coin / Donation
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PART 5 - AMPLIFIED MUSIC & LIVE PERFORMANCE
Is amplified music or live performance proposed?
Yes
No
Is outdoor or live cinema proposed?
Yes
No
Live music start time
Hour : Minutes
Live music end time
Hour : Minutes
NOTES: Under the State Environment Protection Policy, amplified music or live performance are managed by the Environmental Protection Agency of Victoria. Events must ensure that noise must not exceed 65 dbA at the closest residential premises to the event site and that operating times must be between 12:00pm and 11:00pm or 12:00pm and 10:00pm for events longer than 5 hours. Exemptions to these requirements may be requested from the EPA via their website. Dependent on the extent and duration of amplified music and/or noise, extensive communication may be required including (but not limited to) letter box drops, on-road signage prior to the event and advertising in local newspapers.It is up to the event coordinator to ensure that appropriate approvals regarding copyright are sought from relevant authorities including APRA-AMCOS, PPCA and cinema licencing distributors.

SITE PLAN: Please mark the location of entertainment stages including speaker direction on your site plan.

ATTACHMENT REQUIRED: For live performances, please include a running order for your event including rehearsal and sound check times. If you are applying for amplified music at a duration longer than prescribed by the EPA policy (above) please include a copy of the SEPP-2 Exemption as provided by them.
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PART 6 - ROAD EVENTS
Any event with road closures or changes to traffic conditions will require additional approval from Council, Victoria Police and/or VicRoads dependent on the road. In all instances, a suitably qualified traffic management company should be engaged to design traffic management plans and ensure compliance with relevant law. Council does not provide personnel or equipment to manage road events.
Are Road Closures or changes to traffic conditions required?
Yes
No
Please list any affected roads/intersections
Traffic Management Company Details
Traffic management company
Contact

Prefix
First Name
Last Name
Contact number
How will you advise residents and businesses about the traffic changes or road closure?
NOTES: Where events include a combination of Council and VicRoads Roads, Council may provide provisional approval of your event prior to you submitting to VicRoads and Victoria Police. This provisional approval will be provided at its discretion on review of traffic management plan, public liability insurance and risk management plan.

Dependent on the extent and duration of road closures and traffic condition changes, extensive communication may be required including (but not limited to) letter box drops, on-road signage prior to the event and advertising in local newspapers.

ATTACHMENT REQUIRED: Please attach your Traffic Management Plan from a qualified contractor.
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PART 7 - FIREWORKS
Is it proposed to have a fireworks display?
Yes
No
Pyrotechnician Company Details
Company Name
Contact Name

Prefix
First Name
Last Name
Contact's number
Start time of fireworks display
Hour : Minutes
End time of fireworks display
Hour : Minutes
How do you propose to advise neighbours of your fireworks display
NOTES: Fireworks displays are regulated by Worksafe Victoria and must be conducted by a licensed pyrotechnician. Council will only approve events involving fireworks where a Notification of intention to discharge fireworks has been submitted to Worksafe Victoria. Fireworks displays will not be permitted on Total Fire Ban Days and may not be conducted within 50 metres of a dwelling

Dependent on the extent and duration of fireworks displays, extensive communication may be required including (but not limited to) letter box drops, on-road signage prior to the event and advertising in local newspapers.

SITE PLAN: Please provide details of exclusion zones and fire fighting equipment provided by your pyrotechnician on your site plan.

ATTACHMENT REQUIRED: Please ensure that the following Is attached to your application:

• Copy of lead pyrotechnician’s license

• Pyrotechnician Public Liability Insurance Certificate of Currency for a minimum of $20 million

• Copy of Pyrotechnician Risk Management Plan

• Screenshot of submitted Notification of Intention to Discharge Fireworks
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PART 8 - AMUSEMENT RIDES
is it proposed to have amusement rides?
Yes
No
Amusement Company Details
Company name
Contact's name

Prefix
First Name
Last Name
Contact's phone number
Number and description of rides
NOTES: Each amusement ride should be registered with Worksafe Victoria as required under OH&S legislation. Each amusement ride should also have current Certificate of Registration of Plant Design and Records of Annual Inspection of Amusement Rides. It is strongly recommended that the event organiser inspects these documents prior to the event to ensure that the rides are compliant.

SITE PLAN: Please show the location of amusement rides on your site plan including vehicle access points and proposed driving path.

ATTACHMENT REQUIRED: Please ensure that the following Is attached to your application:

• Public Liability Insurance Certificate of Currency for a minimum of $20 million for all amusement ride providers

• Copy of Risk Management Plan for amusement ride providers
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PART 9 - ANIMALS
Does your event involve live animals? (including petting zoos)
Yes
No
Animal contractor details
Company name
Contact's name

Prefix
First Name
Last Name
Contact phone number
Description of animals used
NOTES: There are various animal welfare acts, regulations and codes of practice that must be upheld as detailed on the Victorian State Government Agriculture and RSPCA Victoria websites. Events must ensure that they comply with all animal welfare legislation.

Events organisers should also ensure that hand cleansing facilities are provided at points where members of the public can interact with animals.

SITE PLAN: Please show the location of any animal enclosures, rest points, feed and water points on your site map.

ATTACHMENT REQUIRED: Please ensure that the following Is attached to your application:

• Public Liability Insurance Certificate of Currency for a minimum of $20 million for all petting zoo or animal demonstration contractors.

• Copy of Risk Management Plan for animal management, transport and public interaction.
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Part 10 - CAMPING
Does your event require people to stay overnight at the event site to provide security for equipment or infrastructure?
Yes
No
Number of people to stay on site
What washing and laundry facilities will be available?
NOTES: For overnight camping at any Council owned property, additional permits are required. These permits will only be issued where approved ablution facilities are provided for showers, toilets and laundry facilities.

SITE PLAN: Please show the location of any proposed camping areas on-site.
Does your event propose to have overnight camping available for the public?
Yes
No
Proposed location of camping ground
If on private land, does the event have the landholder’s permission?
Yes
No
Number of people to stay on-site
Number of camping sites
What washing and laundry facilities will be available?
NOTES: For overnight camping at any Council owned property, additional permits are required. These permits will only be issued where approved ablution facilities are provided for showers, toilets and laundry facilities.

SITE PLAN: Please provide a separate site plan detailing proposed campground layout including location of campsites, ablution facilities, vehicle access routes, power, lighting and emergency management routes.

ATTACHMENT REQUIRED: Please attach a separate Risk Management Plan and Emergency Management Plan for the proposed campground and facilities. Where your location of camping facilities is on private property, please attach a letter from the property owner providing permission
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PART 11 - FILE UPLOADS AND DECLARATION
SITE PLAN:

You will need to provide a site plan of your event area. As you complete this application, you may be required to

Marquees / tents / structures
- PLAN:Please mark the location of any marquees, tents, structures, platforms, scaffolding or seating stands on your site plan.
Toilets and drink facilities
- Please mark the location of any toilet facilities or drinking fountains on your site plan.
Power Outlets
- Please mark the location of power outlets utilised by the event.
Bins
- Please mark the location of proposed bin collection points, additional waste areas or skip bins on your site plan.
Food vendors
- Please mark the location of any food vendors on your site map.
Alcohol
- Please provide a RED LINE on your site plan to indicate the areas where alcohol will be served and consumed. Please indicate on your site plan locations for free drinking water and alcohol service places.
Camping
- Please show the location of any proposed camping areas on-site.
Animals
- Please show the location of any animal enclosures, rest points, feed and water points on your site map.
Amusement rides
- Please show the location of amusement rides on your site plan including vehicle access points and proposed driving path.
Fireworks
- Please provide details of exclusion zones and fire fighting equipment provided by your pyrotechnician on your site plan.
Amplified music and live event
- Please mark the location of entertainment stages including speaker direction on your site plan.
Please upload your site plan with the details listed above
Filename
Size
Process
Status
Add Files Start Upload
You will need to provide a site plan of your event area. As you complete this application, you may see these green boxes that will indicate what you must include on your site plan. If your event requires a (POPE) you will need to attach 3 scaled plans of the event site when you submit your application.
Public liability insurance
Filename
Size
Process
Status
Add Files Start Upload
Please attach a current Certificate of Currency from your insurer for $20 Million Public Liability Insurance.
Design plans
Filename
Size
Process
Status
Add Files Start Upload
Please attach design plans for any large structures, staging, scaffolding and platforms.
Risk management plan
Filename
Size
Process
Status
Add Files Start Upload
Please attach your risk management plan or the Risk Management Form to this application if you are not using your own.
Emergency Management Plan
Filename
Size
Process
Status
Add Files Start Upload
Please show evacuation points, emergency entry routes, firefighting appliances and first aid locations on your site plan.
ATTACHMENT REQUIRED(Please upload at the end of this form): Prior to your event date, you will need to submit a list of food vendors to Council so we can check that all your vendors have been registered with Streatrader. Please ensure a list is sent through to Council no later than 3 days prior to your event and includes:
- Trading name,
- Streatrader trading number,
- Name and contact number,
- Type of food to be served/sold.
List of food vendors
Filename
Size
Process
Status
Add Files Start Upload
Liquor license
Filename
Size
Process
Status
Add Files Start Upload
Your event permit will only be issued once Council has been provided with your liquor license. Please ensure that you forward a copy of your license once you have obtained it from the VCGLR.
Running order for live performances
Filename
Size
Process
Status
Add Files Start Upload
For live performances, please include a running order for your event including rehearsal and sound check times. If you are applying for amplified music at a duration longer than prescribed by the EPA policy (above) please include a copy of the SEPP-2 Exemption as provided by them.
Traffic management plan
Filename
Size
Process
Status
Add Files Start Upload
Please attach your Traffic Management Plan from a qualified contractor.
Attachments for fireworks application
Filename
Size
Process
Status
Add Files Start Upload
Copy of lead pyrotechnician’s license • Pyrotechnician Public Liability Insurance Certificate of Currency for a minimum of $20 million • Copy of Pyrotechnician Risk Management Plan • Screenshot of submitted Notification of Intention to Discharge Fireworks
Amusement ride file upload
Filename
Size
Process
Status
Add Files Start Upload
Please ensure that the following Is attached to your application: • Public Liability Insurance Certificate of Currency for a minimum of $20 million for all amusement ride providers • Copy of Risk Management Plan for amusement ride providers
Animal file upload
Filename
Size
Process
Status
Add Files Start Upload
Please ensure that the following Is attached to your application: • Public Liability Insurance Certificate of Currency for a minimum of $20 million for all petting zoo or animal demonstration contractors. • Copy of Risk Management Plan for animal management, transport and public interaction.
Camping related document upload including separate site plan, emergency management plan and risk management plan
Filename
Size
Process
Status
Add Files Start Upload
Please attach a separate Risk Management Plan and Emergency Management Plan for the proposed campground and facilities. Where your location of camping facilities is on private property, please attach a letter from the property owner providing permission
Declaration
I have completed this application to the best of my knowledge and have read, understood and accepted the Event Permit Terms and Conditions.
Terms and Conditions:

Please visit the Rural City of Wangaratta website for full Terms and Conditions related to Event Permits at www.wangaratta.vic.gov.au/
Electronic Signature
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Medium or High Impact Event Form

PART 1 - ABOUT YOUR EVENT

PART 2 - EVENT LAYOUT AND INFRASTRUCTURE

PART 2 - EVENT LAYOUT AND INFRASTRUCTURE

WASTE MANAGEMENT

PART 3 - INSURANCE, RISK AND EMERGENCY MANAGEMENT

PART 5 - AMPLIFIED MUSIC & LIVE PERFORMANCE

PART 6 - ROAD EVENTS

PART 7 - FIREWORKS

PART 8 - AMUSEMENT RIDES

PART 9 - ANIMALS

Part 10 - CAMPING

PART 11 - FILE UPLOADS AND DECLARATION

SITE PLAN:

Month	-	Day	-	Year
Hour	:	Minutes

Month	-	Day	-	Year
Hour	:	Minutes

Month	-	Day	-	Year
Hour	:	Minutes

Month	-	Day	-	Year
Hour	:	Minutes