Fire Indicator Panel Isolation And De-Isolation Permit

About this form
It is prohibited to do any building or maintenance work in PMNSW building elements containing ACM or where it is presumed to be present, without formal written approval by PMNSW Authorised Representative.

Applications to be submitted a minimum of 7 working days excluding weekends and public holidays prior to the proposed work date. All documentation must be submitted with this application or the application may not be assessed.
Approval requires the following criteria to be met and information provided to the PMNSW Representative along with a Safe Work Method Statement prior to work commencement.
The permit is only valid for the time specified on the permit.
A copy of this permit must be carried and produced upon request.

How to complete this form

Ensure that all fields have been filled out correctly.
Please note that all fields on this form are mandatory and must be completed before submitting the application.
Once completed this form is to be submitted online.
Documents must use .pdf format and have a filename that does not exceed 255 characters.
A risk assessment must be undertaken and attached to this permit along with a SWMS

Please nominate which category your permit application relates to from the selection below:

Projects

Facilities Management

Events/Activations/Installations

Private Applications

Tenant

Location

Darling Harbour

Rocks Precinct

White Bay

Application Type*

Tenant

Business Entity

Contractor

Section B

Location*

Levels*

Rooms

Street Number*

Between Streets*

and

Suburb*

Reason for Isolation*

Maintenance

Construction

Section C - REQUIREMENTS

Isolate at building* (for areas/levels only)	Yes No	Isolation occurring under the following conditions Less than 12 hours only, during business hours 6am-1800, less than 20% of building isolated. * (ie: daily)	Yes No
Isolate at security office* (for more than 20% of the building)	Yes No	Isolate for more than 12 hours or overnight (ie: continuous)	Yes No

Isolation start: *


	:

End: *


	:

Fees

For works contracted by PMNSW or CBRE fees may be waived, please complete this section as required and fees will be assessed pre approval.

Application fee

$133.00

These fees are exempt from GST as Division 81 Fees & Charges.

SECTION D - DOCUMENTS

RISK ASSESSMENT DOCUMENT

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*Only Accept Adobe Acrobat Document (.pdf)

SAFE WORKING METHOD STATEMENT - This should outline exactly how the works will be carried out, identify all potential risks and what controls will be implemented and demonstrate how people will be protected from these risks, including falling debris/equipment, falls from a height, security of the site, trip hazards, traffic risks"

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*Only Accept Adobe Acrobat Document (.pdf)

INSURANCES - Insurances must be included with the application with the following;
1.Minimum $20 million public liability insurance
2.Expiry date
3.Permit Management New South Wales MUST be noted on the policy cover sheet as an "Interested" party

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*Only Accept Adobe Acrobat Document (.pdf)

Acknowledgement of Application

DECLARATION*

I declare that a notification of isolation has been forwarded to all relevant tenants of the property a minimum of 7 days prior to the isolation of the fire indicator panel

I declare that all information and plans that have been submitted are correct and that I will comply with all conditions of the approval.

I declare that the person/s performing the isolation and de-isolation are authorised and qualified to perform those tasks.

I declare I have assessed, downloaded and will abide by all the rules, regulations & standards as included in this HSE Induction Document.

I declare I have assessed, downloaded and will abide by all the rules, regulations and standards as included in this Construction and Works House Rules.

Fire Indicator Panel Isolation And De-Isolation Permit

Section A - Application Details

Section B

Section C - REQUIREMENTS

SECTION D - DOCUMENTS

Acknowledgement of Application