Fillable Cook, Wujal Wujal, Hope Vale: COVID-19 entry permit application form (March 2020, v10)

Fill Online, Printable, Fillable, Blank Cook, Wujal Wujal, Hope Vale: COVID-19 entry permit application form (March 2020, v10) Form

Use Fill to complete blank online DEPARTMENT OF THE ENVIRONMENT AND ENERGY pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Cook, Wujal Wujal, Hope Vale: COVID-19 entry permit application form (March 2020, v10)

On average this form takes 11 minutes to complete

The Cook, Wujal Wujal, Hope Vale: COVID-19 entry permit application form (March 2020, v10) form is 2 pages long and contains:

  • 0 signatures
  • 12 check-boxes
  • 39 other fields

Country of origin: AUSTRALIA
File type: PDF

Use our library of forms to quickly fill and sign your Department of the Environment and Energy forms online.

BROWSE DEPARTMENT OF THE ENVIRONMENT AND ENERGY FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Cook Shire Council
Ph: 07 4082 0500
www.cook.qld.gov.au
COOK, WUJAL WUJAL, HOPE VALE SHIRES
COVID-19 ENTRY PERMIT APPLICATION
• Print out the completed form and take to Mt Carbine checkpoint or airport.
• Email a copy of completed form to covid19@cook.qld.gov.au
• Entry for Cook, Wujal Wujal and Hope Vale Shires only and does NOT authorise entry to other Aboriginal Shire
Councils or Weipa.
• All persons arriving by plane at any airport in these Shires will be subject to the same controls as for travel by
roads into Cook. That is, each person must provide a valid entry permit.
• People arriving by boat will be subject to the controls of Maritime Safety Queensland.
• These restrictions apply to everyone except emergency and defence force personnel in uniform on duty.
• Where possible, applications must be made at least three (3) full business days prior to planned travel.
• Every individual entering these Shires must have a printed copy of the entry permit along with photo
identification for presentation at the access checkpoints at Mt Carbine or airport.
Section 1 – Applicant details
First name: Last name:
Company name:
Residential Address:
Town: State: Postcode:
Postal address:
Town: State: Postcode:
Mobile: Email:
Photo Identification Type: ID Number:
Photo Identification attached: YES NO
Section 2 – Vehicle Details, if applicable
Vehicle type: Make / Model:
Vehicle colour: Registration:
Section 3 – Conditions of permit consent
A completed application DOES NOT guarantee approval
(a) Entry permit for Cook, Wujal Wujal, and Hope Vale Shires only.
(b) Other than for entry into Hope Vale and Wujal Wujal Shires, this permit does NOT authorise entry to other
Aboriginal Shire Councils or Weipa.
(c) Permit is valid only when carried on the person along with Photo Identification.
(d) Permit applies for the purpose issued and vehicle listed only.
(e) All persons travelling on airlines will be subject to the same controls as for travel on roads.
(f) Every person in a vehicle must have a valid entry permit.
(g) The only exceptions are emergency and defence force personnel in uniform and on duty.
(h) A permit holder is required to abide by Queensland Health recommended actions in relations to personal hygiene
and social distancing. For more details refer to the Queensland Health website.
(i) This permit does not authorise travel on any closed roads. A separate permit is required to travel on closed roads,
for details visit Council Website.
(j) For access to the State-controlled Peninsula Development Road, contact the Department of Transport and Main
Roads on 13 19 40.
(k) The permit holder indemnifies Cook, Wujal Wujal and Hope Vale Councils against any claim for vehicle damage,
personal injury, illness or any other loss arising howsoever from entry granted by this permit.
COVID-19 Entry Permit – 25 March 2020 Page 1 of 2
Section 4 – Reasons for Travel
Which of the following classes best describes the reason for your travel. NOTE, only 1 option permitted.
In addition to photo id, please include the documents indicated, if available, with your permit application
Medical and health service professional
Provide: Declaration of need of travel from employer (i.e. letter, doctor’s certificate)
Service provider required to maintain critical infrastructure
Provide: Declaration of need from organisation contracting the works
Commercial freight company
Provide: Declaration of operation as a general freight and transport company servicing residents or businesses
travelling to and from these Shires.
Primary producer moving livestock and produce
Provide: Documentation detailing essential movements (e.g. freight, destination)
Exceptional personal circumstances
Provide: Statement of need and any supporting documentation considered appropriate (e.g. medical certificate
defining clinical treatment)
If Returning resident – Provide Proof of residency for localities throughout the Cape. Note: may be required to self
isolate for 14-days
Details /justification:
NOTE: Please, attach additional information if required.
If work related:
Employer name:
Contact person: Phone/Mobile:
Mobile: Email:
Section 5 – Travel details
Entry status: Permanent Temporary If temporary, are you staying overnight: YES NO
Arrival Date: Departure Date, if relevant:
Intended Destination (i.e. Town):
Accommodation:
Address: Phone/Mobile:
Section 6 – Returning residents declaration
Please complete the following statement
I, , voluntarily undertake to self isolate for 14-days at the following address:
Town:
Applicant Name: Signature:
Lodgement
By signing this form the applicant acknowledges that they have read, understand and agree to abide by the
permit conditions
Applicant's name: Date:
Signature:
You are providing personal information which will only be used for Council business activity specific to your enquiry, request, or ap -
plication. Your personal information is managed in accordance with the Information Privacy Act 2009, will only be handled by persons
authorised to do so and will not be disseminated unless you have given Council permission to do so or the disclosure is required by law.
COVID-19 Entry Permit – 25 March 2020 Page 2 of 2
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Cook, Wujal Wujal, Hope Vale: COVID-19 entry permit application form (March 2020, v10)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 29 March 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document