Fillable Explosives-application-formQD156-2018 QD156 - Application for a Storage Licence under the Explosives Regulations 2014

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Explosives-application-formQD156-2018 QD156 - Application for a Storage Licence under the Explosives Regulations 2014

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QD156
a
Application for a Storage Licence under the Explosives Regulations
2014
• Please read the guidance notes before completing this form.
• You should not use this form for an application for a licence to store the
explosives listed in note 1
•
You should only use this form if you want to store no more than 2000kg of explosives.
• If there is insufficient room to provide the information requested, please continue on
a separate sheet(s) (see note 2)
• Please note that it is an offence under Section 33 of the Health and Safety at Work etc
Act 1974 to provide false information. Incomplete or inaccurate information
could result in a delay in the processing of your application.
•
The information contained in this form may be stored electronically. The information
may, where appropriate, be shared with other relevant bodies such as other local
licensing authorities or the Health and Safety Executive. You have the right to
request a copy of any personal information and to have any inaccuracies corrected.
•
Please complete this form using either black ink or type.
The application is for
: [tick the box that applies]
New storage licence Renewal storage licence
If this is a renewal application, pl
ease state the date of expiry and any reference number
Expiry Date
Reference No.
Nature of business: [tick the category or categories that apply to this application]
Fireworks – retail Fireworks-import/wholesale Fireworks-display operator
Recreational user
Other [please specify)
Are you applying for a licence where the storage will be subject to separation distances? (See note 5)
Yes No
•
We shall use this information to process your application for an Explosives Storage
Licence. The data collected is in accordance with current data protection legislation
and will be used only for the purpose outlined in this form (please note that key data
may also be provided to Leicestershire Fire and Rescue Service). For further
information on how this data will be processed please see the Fair Processing Notice
on our website at -
www.leicestershire.gov.uk/about-the-council/data-protection-and-privacy
ER1 (07/18)
Page 1 of 6
V3-15/08/18
Details of the applicant: [if you are applying on behalf of a company or limited liability partnership (or, in
Scotland only, a partnership), please give its name].
Name of applicant:
Companies House No
(if applicable)
Date and place of birth [where applicant is an individual]
N.I. no [where applicant is an individual]
Address [including postcode]. If the applicant is a company, please give the registered office
Daytime telephone number:
Mobile number:
Email:
Full address
(including postcode) of the where the explosives will be stored:
Do you have an explosives store at an address different to that above? Yes No
If yes, please provide the full address including postcode of this store:
Do you have a licence for this store? Yes No
. If yes, please provide the licence number and
date of expiry
Licence Number Date of Expiry
If the applicant is not the owner/manager of the business, please give the details of the
person with management responsibilities for the store.
Name Position
Address including postcode
[if different from above]
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V3-15/08/18







Contact telephone number
Email:
Out of hours contact details [if different from above] – please give the name and telephone number,
including mobile if appropriate, of the person to be contacted in an emergency.
Name of contact
Telephone No. Mobile No.
Explosives to be kept and quantities
Hazard T
p
e or UN number
A
mount
(
net mass
–
k
g)
[Please tick the box or boxes that apply]
1.
Are you (the applicant) intending to store more than 75kg (net) of ammunition or
pyrotechnic articles
in a building that ajoins domestic premises?
Yes No
2.
Have you (the applicant) had a previous licence or registration
refused or revoked?
No
3.
Have you (the applicant) been convicted of any offence under legislation on health and
safety? (See note 4)
4.
Have you (the applicant) been convicted of any other offences relating to the storage, sale,
supply, importation or posses
ion of fireworks and/or any other explosives? (see note 4)
No
5.
Have you (the applicant) been convicted of any offence under any other legislation
including offences against the person, dishonesty offences and offences relationg to the
supply of controlled drugs? (see note 4)
If you have answered “Yes” to any of questions 2-5, please give date(s) and details, including the licensing
authority and court where convicted
Yes
Yes
No
Yes
Yes
No
ER1 (07/18)
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V3-15/08/18
Signature of applicant [or applicant’s representative]
By signing this form you agree to the information provided, in relation the explosives stored e.g. the type and quantity,
being shared with the emergency services in the event of an incident. If signing on behalf of a company you should be
a Director or enclose documentary evidence that this application has been approved by the board of directors.
It is an offence under Section 33 of the Health and Safety at Work etc. Act 1974 to provide false information.
Signed
Date
Name Position/Job title
Organisation
[if applicable]
The completed application form, together with the following documents in support of the
application, should be sent to your licensing authority.
[Please tick the boxes to confirm the following
have been submitted]
Application fee: [
see note 10] [If you are unsure of the fee, please ask your licensing authority]
Supplementary information sheet (if applicable) [see note 2]
Plan of the site: [see notes 6, 7 & 11]
Floor plan: (if explosives are to be kept on the shop floor or in a building that is to be used for
other purposes as well as the storage of explosives) [see note 8,9 & 11]
For licensing authority use only:
Application form completed
Fee enclosed
Site Plan enclosed
Building Floor Plan enclosed
(if applicable)
Please return form to:
Leicestershire County Council
Trading Standards Service
County Hall
Glenfield
Leicestershire
LE3 8RA
Cheques to be made payable to: Leicestershire County Council
ER1 (07/18)
Page 4 of 6
V3-15/08/18
Guidance to applicants
IMPORTANT It is your responsibility to ensure you are aware of, and comply with, the Explosives Regulations 2014.
The licensing authority has the power to prohibit storage of explosives at the site if it believes the site is no longer
suitable. It may also take enforcement action if you are not storing safely.
If you are intending to supply fireworks outside the normal permitted period’s e.g. New Year, Chinese New Year,
October 15
th
-November 10
th
and Diwali, you will also need to make a separate application to your local licensing
authority for a licence to comply with the Fireworks Regulations 2004.
General information on completing the application
1.
This form should not be used for an application for a licence to store the explosives listed below:
-
relevant explosives (an explosives certificate is required to acquire or keep the explosives)
-
ammunition the acquisition of which is regulated or prohibited by virtue of the Firearms Acts 1968 to 1997
-
smokeless powder or percussion caps
-
explosives stored by a person who is registered as a firearms dealer under section 33 of the Firearms Act 1968
If you want to store the explosives listed above, you should use form ER2
You should only use this form if you want to store no more than 2000kg of explosives. If you want to store
more than 2000kg of explosives you should apply to the Health and Safety Executive for a licence. Further
information on licensing can be found at www.hse.gov.uk/explosives/licensing/how-to-apply.htm
2.
If there is insufficient room to provide the information requested, please continue on a separate sheet(s). You should
also put your name and address at the top of each sheet before attaching the sheet(s) to your application form.
3.
Please contact your local licensing authority if you have any questions about completing this form or about your
application. If you live in the metropolitan counties (i.e. West Midlands, Merseyside, Greater Manchester, Tyne and
Wear, South a
nd West Yorkshire) or in Oxfordshire, Cornwall or Norfolk, you will need to apply to the fire and rescue
service. In other areas you will normally need to contact the trading standards department of your local authority.
4.
Please note: Any previous convictions you may have may be subject to the Rehabilitation of Offenders Act 1974
and you do not have to include convictions that are ‘spent’ on this application form. The Rehabilitation of Offenders
Act does not apply to corporate bodies or companies. Where the application relates to a corporate body or company
convictions of all directors should be listed. Where the application relates in Scotland to a partnership, convictions
of all partners should be listed. Information on how Licensing Authorities will consider the relevance of previous
convictions to an application for a licence can be found at www.hse.gov.uk/explosives/index.htm
5.
Separation distances - please see Regulation 27 of the Explosives Regulation 2014. You will not normally be
required to maintain separation distances if you store no more than:
-
250kg HT4
-
25kg HT3 (or combination of HT3 and HT4)
-
0.1kg HT1
-
0.1kg HT2
on one site. If you are unsure whether your store or on places where you will be manufacturing or processing
explosives on site are subject to separation distances, contact your local licensing authority
ER1 (07/18)
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The following documents should be submitted with the application form:
6.
A plan to a scale sufficient to show the location of the site in relation to its surroundings (i.e. named or numbered
roads, hamlets, villages or geographical features). Where the site does not have a postal address this should
normally be a minimum scale of 1:25000.
7.
If the store is subject to separation distances you will also need to provide an Ordnance Survey Siteplan (or similar)
map showing the location of the store and distances to any neighbouring buildings. The plan should also show any
areas where you intend to process or manufacture explosives where a licence for those activities is not required
under regulation 6 of ER2014. The scale will depend on the separation distance. For a distance of up to 200
metres, a 1:1250 would normally be required while greater distance would require a 1:2500 or even a SuperPlan.
Where this plan clearly identifies the location of the site in relation to its surroundings it can be substituted for the
plan referred to in 6 above.
8.
If you intend to store or display more than 12.5kg of fireworks on a shop floor, the licensing authority will require
you submit a floor plan of the sales area.
9.
If you intend to store, process or manufacture explosives within a building that is also used for other purposes you
should include a floor plan showing the places within the building where you intend storing, processing or
manufacturing the explosives.
10.
The fee must also be submitted with the application. Information on fees can be found at
www.hse.gov.uk/explosives/licensing/fees.htm, or contact your licensing authority for advice.
Hazard type and quantity
11.
The licensing authority will need to know the hazard type and quantity of the explosives you wish to store to
determine whether your store is suitable. The quantity you will be allowed to store will depend on the hazard type
of the explosives. Please contact your supplier if you are uncertain about the hazard types of explosive you wish
to store.
The “quantity” refers to the ‘net mass’ of the explosives. This means the weight of the explosive contained within
an article i.e. less packaging, casings, etc
Period of validity
14.
13.
If there have been no relevant changes to the site usage, layout or places where explosives are stored, or to the
proximity of protected places to the stores since the licence was originally granted or last renewed, then it will not,
in general, be necessary for a new plan to be submitted to your licensing authority.
Renewal of licence
Most employers are required by law to insure against liability for injury or disease to their employees arising out of
their employment. The Employers’ Liability (Compulsory Insurance) Act 1969 ensures that you have at least a
minimum level of insurance cover against any such claims. For more information visit
http://www.hse.gov.uk/pubns/hse40.pdf
15.
Public liability insurance is not required by health and safety law. However, if you are manufacturing or storing
explosives (including fireworks) you may wish to take out public liability insurance. Many industry trade associations
and professional bodies require this as a condition of membership. Professional display operators using category F4
fireworks, T2 theatrical pyrotechnics or P2 pyrotechnic articles are required by product safety law to have public
liability insurance in place covering their use.
16.
12.
Insurance
Licences for fireworks and other explosives that do not require an explosive certificate may be granted for up to 5
years as the licensing authority determines.
ER1 (07/18)
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V3-15/08/18
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