Application to carry out works on a Council road (including pathways)

Applicant/Owners Details

This application will be processed within 10 working days.

Applicants Name *

Contact Person *

Current Postal Address *

Email Address *

Contact Telephone Number *

Location of the activity *

Lot Number *

Plan Number *

Public Liability Insurance Details

Public Liability Insurer *

Policy Number *

Amount of cover *

Expiry Date * +

Attach copy of insurance policy *

Description of Activity

Details of use *

Residential ($0.00)

Commercial ($120.00)

Current Total:

$0.00

Fee current 2023-24 Financial Year

Brief description of the activity *

Impact of the activity on vehicular or pedestrian traffic *

Date (s) of works to be undertaken from * +

To * +

If requested attach Traffic Management Plan (TMP) (detailing movement of vehicular traffic in the surrounding area)

Declaration

I apply for a Prescribed Activity Permit to Carry out works on a Council Road under Local Government Act 2009 & Local Government Regulation 2012 and declare:

1. The particulars provided above are correct in every detail.

Enter the word in the image *
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Date * +

Standard Conditions

All work is to be completed to the satisfaction of Council representatives & subject to the local laws of the Charters Towers Regional Council, Workplace Health & Safety Legislation (Qld), the Environmental Protection Act and other applicable laws.
Before proceeding with any work the applicant must give notices to, and obtain relevant approvals, permits & consents for utility providers (Telstra or Ergon), Police & Main Roads for roads under their control and comply with their requirements.
The applicant is to indemnify Council against any public injury & or property claims arising from the works.
The applicant agrees to pay all costs & charges incurred in the reinstatement to Council standards, any damage caused to the road, street furniture, constructed kerbing & water channelling, stormwater system and or constructed footpath or public services as a result of the activities associated with the work stated, whether by their own operation or those of their sub-contractor, agents, manufacturers, cartage contractors or other deliver or removing from the site.
Notify and liaise with adjoining residents / business owners of the proposed work.
Establish a Work Safety Plan / Work Method Statement for the High Risk Activity (i.e. Work on or near a road) necessary under WHS legislation (Qld) and ensure activities at the workplace are safe and without risk to members of the public.

Work is not to commence until such time as the Charters Towers Regional Council gives approval.

When working on roads or conducting road works the following issues must be considered:

Apply to the Queensland Police Services and/or Main Roads for permits and consent.
Erect official road works signage.
Delineate the road/parking area closure and or works as recommended In Main Roads “Manual of Uniform Traffic Control Devices 2003”.
Only utilise accredited / licensed traffic controllers for traffic duties.

Note: When closing the road entirely you must notifying the Queensland Ambulance and Queensland Fire & Rescue Services.

Work Safety Plan or Work Method Statement

WHS legislation (Qld) requires work method statements to be prepared for high-risk construction activities such as working on, or adjacent to a road prior to commencing such activities. In addition the following samples of high-risk construction activities may also be encountered and should be included in the work method statement.

Using a hazardous substance.
Working at heights of 2m or more
Structural alterations that require temporary support to prevent collapse.
Moving powered mobile plant at the workplace.

For further information or a full list of High-risk Construction Activities refer WHSQ at:

http://www.dir.qld.gov.au/workplace/index

Tel. 1300 369 915