Fillable 2018-09-11-fireworks-display-form-v2 Fireworks display form

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2018-09-11-fireworks-display-form-v2 Fireworks display form

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DETAILS OF ORGANISER
Name…………………………Address………………………………………………………….
………………………………………………..Tel. home………………… work ………………
Mobile contact number: …………………..
EVENT DETAILS
Date: ……………………………………….. Time: ……………………………
Location of bonfire or display (be precise)
……………………………………………………………………………………………………..
Number of spectator’s invited/expected:
1. Will there be a bonfire?
YES NO
2. If yes, Is it on a flat suitable site, at least 15mtr away from buildings,
highways, overhead power lines, etc?
YES NO
3. Have you nominated a person responsible for the display or bonfire?
i.e collecting material for it, building it, lighting it ?
YES NO
4. Have you taken precautions to ensure no hazardous materials are
put on the bonfire? Eg: highly flammable materials, material that
may emit toxic fumes or fibres.
YES NO
5. Are you having fireworks?
YES NO
6. If YES, have you appointed a professional Firework Operator?
If YES. Please provide name, address and Tel no.
……………………………………………………………………………………………
……………………………………………………………I………..
YES NO
7. If NO, have you nominated your own responsible person?
If YES. Please provide name and contact Tel no.
……………………………………………………………………………………………
……………………………………………………………I………..
YES NO
8. Have you provided a safe and secure place to store them before use?
YES NO
9. Have you identified: the firing area
the safety area
the fall-out area
the bonfire area
YES NO
YES NO
YES NO
YES NO
ENVIRONMENTAL HEALTH SERVICES
BONFIRE / FIREWORK DISPLAY INFORMATION FORM
Venue:
Office Use only:
Ref:
10. How will you make sure no unauthorised person or child enters the firing area, safety area
and fall-out area? Provide details.
…………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………
11. Have you identified emergency service routes to site and made arrangements
to keep routes clear of obstructions and accessible at all times during the event? YES NO
12. Have you provided a communication system between display organiser and staff? YES NO
13. Is there a suitable PA system to make announcements to the public? YES NO
14. Are systems in place for the removal and safe disposal of hazardous or unsuitable
material for bonfires? YES NO
15. Have you organised the cleaning up of debris etc after the event? YES NO
16. If something should go wrong, have you got a procedure in place? (Consider burns from
Sparklers, accident with a firework, bonfire getting out of control, cancelling due to adverse
weather, people bringing their own fireworks on site.) Provide details
…………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………
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…………………………………………………………………………………………………………………………
…………………………………………………………Have you provided first aid facilities? YES NO
………………………
YES NO
If further information is required, please provide name and contact no if different from above.
Name…………………………………Tel. No work………………home………………….
Return to; Jackie Hall, Public Protection Service, Floor 3, Number One Riverside, Smith Street,
Rochdale, OL16 1XU, Jackie.hall@rochdale.gov.uk At least 10 days before the event.
Signed…………………………………………………………………………………date……………………….
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2018-09-11-fireworks-display-form-v2 Fireworks display form

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Completed 5 July 2020

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