Form CG3 / / File No…………………………

CARE GROUP PROJECT PLAN

Care group name:......

Location:......

Care group leader:......

BOPRC staff member:......

Project name:......

Contact person for this project (if not care group leader):......

Address:......

......

Telephone:...... Mobile:......

Facsimile:...... Email:......

How many members of your care group will be involved in this project?

List names:

NameAny relevant qualification (e.g. Growsafe)

......

......

......

......

List any other groups or organisations involved in your project.

Organisation name / Contact person / Phone number(s)

List any other groups or organisations involved in your project.

Organisation name / Contact person / Phone number(s)

Purpose of project:

......

......

......

......

......

......

Project timeframes:

Expected project start date:......

Expected project completion date:......

Project description:

(What you want to do and why you want to do it)

......

......

......

......

......

......

......

Project location

Provide a clear map showing where your project will take place, ensure reference points, i.e. names and roads are included. Attach any additional detailed site plans.
Location:......
Address:......
Attach map here

Form CG3 Care Group Project Plan1

Project plan

Primary Activity:...... /

1.1Jan

/ Feb / Mar / Apr / May / Jun / Jul / Aug / Sep / Oct / Nov / Dec /

1.2Jan

/ Feb / Mar / Apr / May / Jun / Jul / Aug / Sep / Oct / Nov / Dec
Tasks / 20___ / 20___
Monitoring:
Primary Activity:...... /

1.3Jan

/ Feb / Mar / Apr / May / Jun / Jul / Aug / Sep / Oct / Nov / Dec /

1.4Jan

/ Feb / Mar / Apr / May / Jun / Jul / Aug / Sep / Oct / Nov / Dec
Tasks / 20___ / 20___
Monitoring:
Primary Activity:...... /

1.5Jan

/ Feb / Mar / Apr / May / Jun / Jul / Aug / Sep / Oct / Nov / Dec /

1.6Jan

/ Feb / Mar / Apr / May / Jun / Jul / Aug / Sep / Oct / Nov / Dec
Tasks / 20___ / 20___
Monitoring:
Primary Activity:...... /

1.7Jan

/ Feb / Mar / Apr / May / Jun / Jul / Aug / Sep / Oct / Nov / Dec /

1.8Jan

/ Feb / Mar / Apr / May / Jun / Jul / Aug / Sep / Oct / Nov / Dec
Tasks / 20___ / 20___
Monitoring:

If additional planning pages are required, photocopy and add to your project plan.

Budget (GST exclusive costs required)

Month/Year / Activity: / Materials/contract labour etc. / Unit
Kg, m, etc. / Rate
$/unit / Total
cost / BOPRC / Org1 / Org2
Tasks
Activity sub-total:
Activity:
Tasks
Activity sub-total
Project total cost:

Form CG3 Care Group Project Plan1

Land ownership

Specify details of the land ownership where your project will occur:

Name:......

Address:......

......

If your group is not the landowner you will need to provide written permission from the landowner.

Resource consents(tick)

Does your project require any resource consents? YesNo

Have you applied for the resource consents?YesNo

Have you been granted the consents?YesNo

Attach a copy of any consents related to this project granted by Bay of Plenty Regional Council or a district or city council. If you are unsure whether your project requires a consent please contact one of Bay of Plenty Regional Council’s Environmental Consents Officers on
0800 884 880 or district or city council.

Archaeological sites/cultural(tick)

Does the location show any archaeological sites on the BOPRC database? YesNo

Has a site inspection identified any possible archaeological sites?YesNo

If you answered yes to the above, has an archaeologist been consulted?YesNo

Does the plan need to incorporate protection of these sites?YesNo

Has the plan undertaken appropriate archaeological site protection measures? YesNo

Has the plan incorporated local cultural customs and protocols where relevant?YesNo

Health and safety planning (tick)

Have you undertaken a hazard assessment of the project location? Yes No

Have you identified any particular health and safety issues or hazards,
on-site and off-site, at this location?YesNo

These are noted below (attach another sheet if required):

Hazard/health and safety issuesAction to ameliorate

......

......

......

......

......

......

Do you require a traffic management plan? (Attach if needed)YesNo

Have you organised a first aid kit to be available at each activity? YesNo

A trained first aider will be present at each activity?YesNo

Consulted neighbours?YesNot appropriate

Made arrangements for your volunteers to have a health and safetyYesNo

inductionbefore any activities commence?

Project plan prepared by:

Name:......

Role:......

Signature:...... Date:......

Project plan agreed by Bay of Plenty Regional Council

Name:......

Position:......

Signature:...... Date:......

Form CG3 Care Group Project Plan1