FILMING PROPOSAL FORM
About this form
You can use this form to apply for approval to undertake any filming or still photography activities in the outdoor areas such asfootways, roads, parks &other spaces within the City of BrokenHill.
Howto complete thisform
1. Ensure you have read theBroken HillCity Council Policy on Filming
2. Fields marked with an * are mandatory
3. Once completed you cansave this formasa separatedocument and submit via email or fax with all the necessary documents.
Part1:ApplicantDetails(This personwill need to be on set at all times)
Title*Given Name/s*FamilyName* OrganisationName*
ABN*Position
OrganisationAddress*
Business Number*Mobile Number* Email Address*
Have your Applicant Details changed since your lastapplication? YesNo
Signed by applicant or personsigning on behalf of the applicant –please state in what capacity
Signature:
Name:
Capacity: Date:
Part2:ProductionContactDetails
Producer
Name*
Email Address*Mobile Number*
Location Manager
Name*
Email Address*Mobile Number*
ProductionManager
Name*
Email Address*Mobile Number*
Unit Manager
Name*
Email Address*Mobile Number*
Barricading/SafetyOfficer
Does a safety plan for this location exist? YesNo
If so please provide the details.
Part3:ProductionDetails
Name of Production
Production Summary (maximum 100words)
Nature of Activity (please tickappropriate box)
Still Shoots/PhotographyTelevision drama and seriesDocumentaries, short films, children’sproduction
TelevisioncommercialFeaturefilmsDVDOther
For multiple,complex activities using more thantwo locations, attach a separatedocument listing each location’s details based on the format below.
Location One
Date (include proposeddate,tentative/backup/wetweatherdates)
Proposed Location (includestreet specific details)
Description ofActivities (exact details ofwhatwillbe undertaken at theproposed location)
Crew call time (please use24 hour clock)Time of filming/photography (please use24 hour clock)
From:To:From:To: Personnel numbers (Detail cast, crew, extras and clients)
Proposed Road Closures and Traffic Control
(includedetailsof users paypoliceor RTA accredited controllers. See Note for more information. If nonerequired write N/A)
Please note-Anyroad closures must be advertised in the local media giving no less than 7 days notice as per
LocalGovernmentAct.
Letter dropsalso need to beundertaken to advise residents / commercial shop ownerswithin the immediate area of the proposed closures. Details includinga map mustbeprovided to City Council /InfrastructureDepartment, and may need to be forwarded to the Local Traffic Committee for their approval. If so, aminimum of 6weekswill be required for approval.
Traffic Controlmust be provided byqualifiedpersonnel, please provide copies of their RTATraffic Control Cards. This mayinclude TCP designand setup or TrafficControlOfficerswithStop/Gosigns.
White Cards maybe required,for personnelundertaking major constructionwork / propson Council Property, should the sitebe classed asa ‘constructionsite’.
Details of proposed equipment & machinery(lighting, generators, cherrypickers, towers. If none required write N/A)
Please note –EWP(elevatedwork platform – cherrypicker) cards mayberequired if in use on council property.
Details of Temporary Structures(e.g. marquees, sets. If none requiredwrite N/A)
Detail listing of any dangeroussubstances that Council should be aware of(If nonewrite N/A)
Pleasespecify any other location relatedinformation(If none requiredwrite N/A)
Catering (Specifylocation and times in 24 hour format.If none requiredwrite N/A)
Parking Details
Essential Production Vehicles (please specifybytype, nature & registration details. Ifmore space is required attach extra sheets andnotebelow)
Production Vehicle Unit Base (pleaseprovideaParking Spaces (specifystreetlocation,numberofspaces& Locationplanmarkbaseonlocationplan) applicableparkingrestrictionsprovidedetailonLocationPlan)
Barricading ofrequired parkingspaces(please use 24hour clock)
From:To:
Location Two
Date (include proposeddate,tentative/backup/wetweatherdates)
Proposed Location (includestreet specific details)
Description ofActivities (exact details ofwhatwillbe undertaken at theproposed location)
Crew call time (please use24 hour clock)Time of filming/photography (please use24 hour clock)
From:To:From:To: Personnel numbers (Howmany? cast, crew,extras andclients)
Proposed Road Closures and Traffic Control(include details of users payPolice orRTA accredited controllers. Please provide copies of all RTATraffic Controlcards. If none requiredwrite N/A)
Note- Anyroad closures mustbe advertisedin the local media giving no less than7 daysnotice as per Local
GovernmentAct.
Letter dropsalso need to beundertaken to advise residents / commercial shop ownerswithin the immediate area of the proposed closures. Details includinga map mustbeprovided to City Council /InfrastructureDepartment, and may need to be forwarded to the Local Traffic Committee for their approval. If so, aminimum of 6weekswill be required for approval.
Traffic Controlmust be provided byqualifiedpersonnel, please provide copies of their RTATraffic Control Cards. This mayinclude TCP designand setup or TrafficControlOfficerswithStop/Gosigns.
White Cards maybe required,for personnelundertaking major constructionwork / propson Council Property, should the sitebe classed asa ‘constructionsite’.
Details of proposed equipment & machinery(lighting, generators, cherrypickers, towers. If none required write N/A)
Please note –EWP (elevatedwork platform– cherrypicker) cards mayberequired if in use on council property.
Details of Temporary Structures(e.g. marquees, sets. If none requiredwrite N/A)
Detail listing of any dangeroussubstances that Council should be aware of(If nonewrite N/A)
Pleasespecify any other location relatedinformation(If none requiredwrite N/A)
Catering (Specify location and times in24 hour format. (If none requiredwrite N/A)
Parking Details
Essential Production Vehicles (please specifybytype, nature & registration details. Ifmore space is required attach extra sheets andnotebelow.)
Production Vehicle Unit Base (pleaseprovideaParking Spaces (specifystreetlocation,numberofspaces& Locationplanmarkbaseonlocationplan) applicableparkingrestrictionsprovidedetailonLocationPlan)
Barricading ofrequired parkingspaces(please use 24hour clock)
From:To:
Part5:SupportingDocumentationChecklist
The followingdocumentsmust besubmitted with your application:
Public Liability Insurance Certificate of currency (refer
Location Plan(including traffic management & parkingplan for each location)
Application for a fee reduction or waiver(optional)
Part6:LodgmentDetails
You can lodge the completed application by:
Email:
Broken Hill CityCouncil- cc Film Broken Hill -
Fax:
Broken Hill CityCouncil- +61(0) 8 80803423
Pleasesaveyour application as aseparate file& forward to the email address above as an attachment along with other supporting documentation.
What now:
Once your application isreceived youwill receive an acknowledgement fromus within 24hrs & will be advised of the expected processing timeof your application.
For further information regarding your application pleasecontact us.
Telephone:
Film BrokenHill - Film Project Co-ordinator - + 61 (0) 8 8080 3564 or
Broken HillCity Council –+ 61 (0) 8 8080 3300
Please note:
If the information on this application is inaccurateor insufficient it may lead to the cancellation of an approval at anytime.
Filming at theBroken Hill Airport - a separate application must becompleted viathe above contacts
Part7:PrivacyPersonalInformationProtectionNotice
Purpose of Collection: For management of parks& open spaces in the Council area.
Intended Recipients: Councilstaff & approved contractors of the Council of the City of Broken Hill.
Film Production & Photography Application is voluntary however acompleted application form is requiredfor filming & photography in the City’s Parks & Openspaces.
Access/Correction:Councilstaff or Freedom ofinformation requests
Storage:Council’s record management systems & archives
OfficeUseOnly
Receiving OfficerDate Received
Comments/notes