Heritage SURVEY REQUEST FORM

Date requested: / Click here to enter a date. /

Internal Use Only

Approved byYMAC: / Click here to enter a date. /
YMAC Code: / Click here to enter text. /

hERITAGE SURVEY REQUEST FORM

-Submit completed survey requests to: PO Box 3072 Adelaide Tce. Perth, 6832 or
-It is the responsibility of the company or individual requesting a survey to ensure that the information supplied on this form is accurate and completed. YMAC may return a survey request if it does not contain sufficient information to coordinate a survey, or if a heritage agreement is not in place.
-The timeframe for coordination of the survey will be calculated from the date on which YMAC approves the survey request, not the date of the survey request. YMAC will provide receipt upon acceptance of the request.

Native title claim group/s:

Click here to enter text.

Proponent information

Proponent Name: / Click here to enter text. /
Street Address: / Click here to enter text. /
Contact Name: / Click here to enter text. / Position: / Click here to enter text. /
Email: / Click here to enter text. /
Mobile: Click here to enter text. / Office: Click here to enter text. / Fax: Click here to enter text.

Invoicing and Approval Information

Is the company submitting the survey request:
a)The proponent and tenement holder conducting the work
b)A subsidiary company of the proponent / tenement holder
c)A separate company or party operating on behalf of the proponent / tenement holder
If yes to b) or c) please provide contact details for the parent company:
Click here to enter text.
Please also advise who YMAC is to contact for the following:
Estimate approval
Name: / Click here to enter text. / Telephone: / Click here to enter text. /
Email: / Click here to enter text. /
Reports/PA Review
Name: / Click here to enter text. / Telephone: / Click here to enter text. /
Email: / Click here to enter text. /
Invoicing
Name: / Click here to enter text. / Telephone: / Click here to enter text. /
Email: / Click here to enter text. /

survey information

Proposed Timeframe

Proposed start date: / Click here to enter text. / Estimated timeframe: / Click here to enter text. /
SurveyType Requested / Survey Model Requested (for surveys only).
Archaeological / Work Program Clearance
Ethnographic / Work Area Clearance
Unknown at this stage / Site Avoidance
For Surveys please also nominate model / Site Identification
Section 16 Investigation
Non-Survey Requests / Unknown at this stage
Salvage
Site Visit
Monitoring
Please refer to ‘YMAC Proponent Guidelines for Conducting a Heritage Survey’ for further information

project areas and priorities

Description of program of work:
Please provide detailed descriptions of the survey and project areas, and also state the proposed land use or nature of proposed development.
Click here to enter text. /
Please indicate the actual areas to be surveyed.
Priority / Project Area Name / Tenement or Lot No /Drill Line ID / Survey Type / Total Area / Length
Choose an item. / Click here to enter text. / Arch Ethno / Click here to enter text. /
Choose an item. / Click here to enter text. / Arch Ethno / Click here to enter text. /
Choose an item. / Click here to enter text. / Arch Ethno / Click here to enter text. /
Choose an item. / Click here to enter text. / Arch Ethno / Click here to enter text. /
Choose an item. / Click here to enter text. / Arch Ethno / Click here to enter text. /
Choose an item. / Click here to enter text. / Arch Ethno / Click here to enter text. /
Past Heritage Surveys in Project Area
Have heritage surveys been performed over the same areas in the past?
If yes, please provide details below and submit a copy the report(s). / Yes No
Author / For (Company) / Year
Click here to enter text. / Click here to enter text. / Click here to enter text. /
Click here to enter text. / Click here to enter text. / Click here to enter text. /
Click here to enter text. / Click here to enter text. / Click here to enter text. /
Click here to enter text. / Click here to enter text. / Click here to enter text. /
Click here to enter text. / Click here to enter text. / Click here to enter text. /

Have project areas been pegged / marked in preparation for the survey?

Yes No

Is the proponent undertaking exploration activity for Uranium or Coal Seam Gas?

If yes, consultation with the Native Title Claim Group may be required prior to scheduling surveys. /

Yes No

Engagement with Native Title Group

Has the program of works been presented at a meeting with the Native Title Group?
If no, this may be requested by the group before surveys are conducted. /

Yes No

MAps and spatial data

Maps

Please note that incomplete or insufficient mapping information may result in delays to acceptance of the survey request form and coordination of the survey. Where YMAC must produce maps, this service will be charged at cost.

Therefore please ensure that all below information is provided with the survey request:

Proposed work area including drill hole locations, access tracks, roads, fence lines, priority areas etc
Tenement/Lot boundaries & Native Title Claim Boundaries
Location/distance from site to nearest town / accommodation / major roads
Topographical maps / satellite imagery

Spatial Data

Please provide spatial data in at least one of the below formats. Excel.csv files with coordinates will be treated as a minimum, and may require further YMAC GIS services, which will be charged at cost. Acceptable datum/projections for coordinates are GDA 94, AGD84, and AGD66 datum, and Transverse Mercator MGA or AMG.

ESRIShapefile (.shp) or Geodatabase (.gdb) / MapInfo (.tab)
Google Earth (.kml) / Excel (.csv)

Personal Protective Equipment

Please list all required PPE that will not be provided by the proponent:

Click here to enter text.

LOGISTICS

Logistics Support provided by the proponentPlease note what logistics (transport, accommodation etc) support the proponent will provide for Aboriginal & Heritage Consultants.

Transport

Flights

/ Hire Vehicles / Pickup at airport/home location / On-site transport only
Accommodation / On Site / Off Site

Meals

/ Yes / No

Eskies/portable fridges in vehicles for survey days?

/ Yes / No
Where transport cannot be provided, ATO rates may apply for TOs own transport. Heritage Consultants invoice hire vehicle fees at cost.
Accommodation booked by YMAC will be invoiced at cost.
4WD Vehicle Access / General Terrain
Mine Spec 4WD / Steep/uneven
Standard 4WD / Flat
No 4WD necessary / N/A - Aerial Survey
Are access tracks to the survey areas cleared? / Yes No

Survey Location & Distances

Name / KMs / Travel time
Nearest town to Site/Accommodation / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Accommodation/Site to Survey Areas / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Nearest Hospital / Click here to enter text. / Click here to enter text. / Click here to enter text. /

Proponent Representative on survey

Name: Click here to enter text. / Position Click here to enter text.
Mobile: Click here to enter text. / Sat Phone: Click here to enter text.
Email: Click here to enter text.

heritage agreements & tenement information

Tenement #

Live/

Pending

Owner

Agreement in place

Date / Year executed

Click here to enter text. /

Choose an item.

Click here to enter text.

/ Click here to enter text. /
Click here to enter text. / Choose an item. / Click here to enter text. / Click here to enter text. /
Click here to enter text. / Choose an item. / Click here to enter text. / Click here to enter text. /
Click here to enter text. / Choose an item. / Click here to enter text. / Click here to enter text. /
Click here to enter text. / Choose an item. / Click here to enter text. / Click here to enter text. /
Click here to enter text. / Choose an item. / Click here to enter text. / Click here to enter text. /
Click here to enter text. / Choose an item. / Click here to enter text. / Click here to enter text. /

Are the agreement(s) executed in the proponent’s name?

If no, please provide Deed(s) of Assignment and Assumption. Otherwise a new heritage agreement may be required. Please contact YMAC Future Acts 9268 7000 for further information. /

Yes

MISCELLANEOUS

Please note any other requirements or comments that are relevant to your request.

Click here to enter text.

Attachments

Please number and list all attachments submitted with this survey request

Attachment

Click here to enter text.

/ Click here to enter text. /
Click here to enter text. / Click here to enter text. /
Click here to enter text. / Click here to enter text. /
Click here to enter text. / Click here to enter text. /
Click here to enter text. / Click here to enter text. /

Preliminary advice and reports

Please note:

-Heritage Survey Reports and Preliminary Advice will be issued in PDF format only

-No data is to be delivered to the proponent without the corresponding recommendations contained within the Preliminary Advice / Heritage Survey Report
-No information is to be delivered directly between the consultant and proponent without the consent of YMAC.
-Please quote YMAC reference code when following up on the progress of your PA/Report

DISCLAIMERs

By submitting this form you acknowledge that survey requests are subject to assessment by YMAC. Notwithstanding the information provided in this form, YMAC may wish tonegotiate changes to the proposed survey to ensure that such work is in accordance with YMAC principles of best practice heritage management and in the best interests of YMAC’s clients.
Once a request has been accepted, changes to the request or scope of works will require a new survey request form. Changes to the scope or works in the fieldmust be negotiated with YMAC. Please submit all requests for amendments to the scope in writingto YMAC.
YMAC requires acceptance of the Survey Request a minimum of 7 days before the commencement of fieldwork. Late amendments or revisions to the request may result in delays to survey timeframes and/or additional costs for which YMAC is not liable.

Signed:

YMAC Use Only
Survey Dates
External Consultant
Internal Staff Member

Internal Staff Budget estimate (Anthropologist / Archaeologist to complete)

Activity

Days

Other Costs

(Please tick)

Other Comments

Survey Preparation

Flights

Desktop Research

Car Hire (# of vehicles req)

Travel

Cab Charges

Fieldwork

Travel Allowance

Preliminary Advice Writing

Credit Card / Sundries

Draft Report

Satellite Phone

Final Report Writing

YMAC Car – Estimate of Km Travel

Mapping / GIS / Accommodation

Aboriginal Consultants TRAVEL ARRANGEMENTS (Heritage Coordinator to complete)

Name

SNR

Location

Distance to Site

TA to be Paid

Contact #