RISK ASSESSMENT FORM

IMPORTANT : This form is to be completed by all individuals, organisations or groups applying to participate at a Townsville City Council Event, who do not have their own Public Liability Insurance to the amount of $20M or who's insurance does not cover the type of activity being performed at a council event.

Privacy Statement:

Townsville City Council collects and manages personal information in the course of performing its activities, functions and duties. We respect the privacy of the personal information held by us. The way in which council manages personal information is governed by the Information Privacy Act 2009 (Qld). We are collecting your personal information in accordance with Local Government Act 2009 so that we can register your attendance and provide updates on the upcoming events. Generally, we will not disclose your personal information outside of Council unless we are required to do so by law, or unless you have given us your consent to such disclosure. For further information about how we manage your personal information please see our Information Privacy Policy.

EVENT DETAILS >>

Name of Event *

Date of the event * +

Location of Event *

YOUR DETAILS >>

First Name *

Last Name *

Organisation (if applicable)

Postal Address Line 1 *

Postal Address Line 2

Suburb *

State *

Post Code *

Phone Number (Work)

Phone Number (Home)

Mobile Number

Email Address *

YOUR INVOLVEMENT DETAILS >>

What is your involvement in the above event? *

Entertainer / Performer

Market Stall Holder / Exhibitor

Food/Drink Vendor

Other (please specify) Other (please specify)

Please describe your activity *

Will you be using electricity at this event? *

Yes

No

What electrical equipment will you be using?

0/120 characters

Has this electrical equipment been tested and tagged by a qualified electrician? *

Yes

No

Does your activity have an element of risk involved? *

Yes

No

Please describe *

Have you ever had a Public Liability Insurance Claim lodged against you and/or your organisation? *

Yes

No

Please give details *

What measures have you taken to minimise the risk to public and yourself? (i.e. no sharp object, securing equipment, training of staff and volunteers etc.) *

I hereby state that the above information is true and correct to the best of my knowledge. *

Yes

Date * +