Four Wheel Drive SA (4WDSA) Affiliated 4WD Club

Old Morgan Quarry Special Event Application Form

(For an event to be held on Council land or land in Council’s care and control)

(Situated at Lot 9, Section 476, Hundred of Eba (Old Morgan Quarry)

All applications must be lodged with Council at least 28 days prior to the event.

1.Event Organiser Details

Organisation/Club
Address:
Trip Leader: / Position / Title:
Phone: / Fax:
After Hours: / Mobile:
E-mail: / Event Mobile:

2.Event/Trip Details

Event Name:
Event Date(s): / From: / To:
Number of Days:
Event Times: / Start: / am / pm / Finish: / am / pm
Venue / Site Preparation Start Date: / Venue / Site Preparation Vacated Date:
Time: / Time:
Description of Event:

3.Insurance

Is the applicant club and this event covered under the annual certificate of insurabce issued by 4WD SA and held by the Mid Murray Council
Yes / No

Please provide a copy of the certificate of currency.

4.Other participating organisations/businesses/groups

Are there any organisations apart from the organising club participating in this event?
Yes / No
If YES, please list.

5.Noise

Will your event include amplified music or speeches, etc? / Yes / No
If YES, please provide details including what will be amplified, volume and times.

Note:It may be necessary to obtain a permit from the Environment Protection Authority for excessive noise.

6.Emergency Services

It is a requirement that prior to any activity/event being held on this land, that all emergency services be advised via facsimile of your attendance on this land on a given date and Trip Leaders contact details. (Facsimile numbers are provided for your assistance)

Have emergency services been notified of the event details and consulted as to their recommendations / requirements?
Yes / No
Police Fax 85402359 / Date of Notification:
Branch Name: / Morgan Police
Requirements:
Fulfilled: / Yes / No
Fire Authority Fax 85402610 / Date of Notification:
Branch Name: / Morgan CFS
Requirements:
Fulfilled: / Yes / No
Ambulance Services
Fax 85402370 / Date of Notification:
Branch Name: / Morgan SA Ambulance
Requirements:
Fulfilled: / Yes / No
Waikerie Hospital Fax 85412928 / Date of Notification:
Branch Name: / Waikerie Hospital
Requirements:
Fulfilled: / Yes / No

7.First Aid Facilities

Will first aid services be available at your event? / Yes / No
If NO, please give details as to why First Aid is not needed at your event.
If YES, who will be providing this service?

8.Temporary Structure Requirements

Will the event include any of the following temporary structures?
  • Stages or platforms
/ Yes / No
  • Break away stage skirts
/ Yes / No
  • Seating stands
/ Yes / No
  • Marques / tents
/ Yes / No
  • Pre-fabricated buildings
/ Yes / No
  • Other
/ Yes / No
Yes / No
Yes / No
Comments:

9.Volunteers

Will volunteers be used at the event? / Yes / No
If YES, please provide details of volunteer roles, insurance, management procedures, training, induction and compliance with the Volunteer Protection Act SA 2001.

10.Risk Assessment and Response

Have all possible risks been identified and ranked? / Yes / No

Note:A Risk Register and a Risk Control Plan template are provided for use.

Have control measures been established for each risk? / Yes / No
Have control measures been implemented for each risk?
/ Yes / No

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The Risk
What can happen and how it could happen? / The Chances of an Incident Happening / Risk Level / How Do We Manage The Risk Now? / Risk Priority:
(e.g. 1, 2, 3 etc)
Likelihood / Consequence

Risk Register

Risk Control Plan

Risk Priority
(e.g. 1,2,3 etc.) / How Could the Risk be Reduced? List possible Options / Preferred Option? (i.e. avoid the risk, manage better, transfer) / Has the Risk Level now Changed ? / Result of Analysis: Accept / Reject the Risk / Person Responsible for Control Option / Timetable for Implementation / How will Risk and Control options be monitored?

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11.Vacating the Site

Arrangements for site clean up:
Arrangements for clean up of surrounds:

12.General Conditions

  1. 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 or claimed against them or any of them arising out of or in relation to the issuing of the permit.
  2. The event organiser shall take out and keep current a Public Risk insurance policy in the name of the permit holder insuring the permit holder for the minimum sum of Ten Million Dollars ($10 000 000) against all actions, costs, claims, damages, charges and expenses whatsoever which may be brought or made or claimed against the permit holder in relation to the activity.
  3. The event organiser or any other participant, where appropriate, shall ensure that it is licensed or registered to carry out the activity authorised by the issuing of this permit.
  4. The permit is not transferable.
  5. The event organiser shall comply with and give all notices required by any Act of Parliament, Ordinance, Regulation or By-law relating to the activity.
  6. Permission is liable to be revoked by Council if the event organiser fails to comply with any condition or in any other justifiable circumstance. The decision of Council will be final.
  7. Permission to commence event will not come into operation until proof of all required documentation has been provided to the Council and a permit, authorised by Council, has been returned to you.

The issuing of this permit is subject to:-

  1. The permit holder agreeing to the General Conditions of the permit as contained herein.
  2. The permit holder agreeing to all “Special Conditions for Permit” which the Council may determine (refer attached).
  3. The permit holder providing a copy of all appropriate insurances as required by either the General Conditions or Special Conditions of permit.

Special Conditions relating to the use of “The Old Morgan Quarry

  1. No Overnight Camping is permitted on the land.
  2. No campfires are permitted on the land.
  3. All dogs must be restrained by use of a leash in accordance with the Dog & Cat Management Act, 1995.
  4. All use of the land must cease prior to the hours of darkness.
  5. No trial bikes or other unregistered motor vehicles of any kind are permitted on the land.
  6. The Gate to the land is to be locked at all times whilst in use, restricting unauthorised entry of the land, except between the hours of 9am and 12mid day, Sundays, when the rubbish transfer station is in operation. During these times, the operator of the transfer station will unlock the gates and then lock them after 12 mid day.

I acknowledge that I have read and understand the permit conditions and agree to abide by the said conditions.

Signed for and on behalf of the organising club:

Name: / Date:
Position: / Signature:

Endorsed by and on behalf of the South Australian Association of Four Wheel Drive Clubs Inc.

Name: / Date:
Position: / Signature:
Council Authorisation
Insurance: / Yes / No / Permit: Approved/Denied: / Fee:
Signed: / Date:

MID MURRAY COUNCIL

M E M O R A N D U M

TO:Four Wheel Drive SA

FROM: Rocky Warren, Manager Regulatory Services

SUBJECT Use Of Council Land, “Old Morgan Quarry”

DATE: 3 June, 2011

The land known as the “Old Morgan Quarry” situated at Section 476, Piece 2 and Part Piece 3, Hundred of Eba, Blanchetown Rd, Morgan, has now been fenced off entirely to the public. In negotiations between Council and the South Australian Association of Four Wheel Drive Clubs Inc. (Four Wheel Drive SA), the land has been made available for use by clubs only affiliated with their association holding their liability insurance. Applications for any future use of this land by 4 x 4 users, must be undertaken by means of the following process.

  1. Application forms may be downloaded from the Four Wheel Drive SA website
  2. Application forms are to be lodged with Four Wheel Drive SA, via email to who will then forward the application form to Council, confirming that the applicant club is affiliated with Four Wheel Drive SA along with a copy of the current insurance policy for that club to use Council’s land.
  3. All applications must be received by Council, no less than 28 days prior to the proposed date of use of the land
  4. On receipt of the application by Council, the application and insurance will be checked, and the date/s required will be checked against the calendar of bookings for the land held by Council. (Four Wheel Drive SA may wish to keep their own calendar).
  5. Council will confirm directly with the applicants (affiliated Club) of the booking/refusal with a copy also being forwarded to Four Wheel Drive SA.
  6. A key for the land will be provided to Four Wheel Drive SA and it will be the onus of the applicant (affiliated Club) to collect and return the key to Four Wheel Drive SA, when gaining access to the land. A deposit may be required by Four Wheel Drive SA
  7. All conditions of use of the land are listed within the application form.

Four Wheel Drive SA

Special Conditions relating to the use of the Old Morgan Quarry

  1. Access is restricted to registered vehicles with third party property insurance acceptable for membership in 4WDSA affiliated Clubs (eg no bicycles, motorcycles, quads etc.).
  2. Visitor numbers limited to 20% of participants
  3. Clubs must abide by their own approved constitutions, club bylaws and 4WDSA Code of Conduct at all times when on Council property
  4. Application to be forwarded to via email
  5. Key must be collected from Arthur J Gallagher 180 Greenhill Road, Parkside - Monday-Friday 08.30am - 4.45pm in the week prior to access
  6. Key must be returned to Arthur J Gallagher 180 Greenhill Road, Parkside- Monday-Friday 08.30am - 4.45pm in the week after access
  7. $ 50 deposit required when key collected - Deposit will be retained if key is not returned on time
  8. Authority to collect key must be presented on club letter head signed by a club committee personwhen key is collected.
  9. Booking is not confirmed until approved by Council and advised by 4WDSA
  10. For further information refer to the 4WDSA website

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