1. Event Details

Name Of Event:

Date of event?
Proposed Venue
Type Of Event

Capacity Of Event

Required Set Up Time

Required time frame to return to original condition

1.2 Event Manager

Event Organiser

Committee Or Organisation hosting event

Contact Phone Number:

Contact Email Address:

Contact Phone Number During Event:

1.3 Description of Event

Describe the event (What is the main attraction or purpose of the event?)

What entertainment is being provided

1.4 Patron Details
Target Audience

Estimate total patron attendance

Patron Age Details: % of total Attendance

0- 12 yrs
12-18 yrs
18-25 yrs
25- 40 yrs
40-55 yrs

Have you registered your event with the Queensland Police Service

Go to

2. General Considerations
2.1 Police Contact

Boulia Police Station
4746 3120

2.2 Service of Liquor

Alcohol to be supplied at the event:

Details regarding the management of alcohol are outlined in Section 6.

2.3 Public Liability

Have you investigated public liability and duty of care issues and obtained appropriate insurance?

Name of company




Policy number

Upload a copy of your insurance Policy here
2.4 Health and Safety

Have all “Stall Holders Checklists” or risk assessments been submitted

3. Consultation with key stakeholders
3.1Consultation Register

Have you contacted QLD Police Service via the Boulia Police Station on (07) 4746 3120

Have you contacted the Boulia Shire Council on (07) 47463188

Have You contacted Queensland Ambulance or equivalent

Have You contacted the Boulia Primary Health Clinic on (07) 4746 2300

If you have not yet consulted with any of the above mentioned stake holders please do so before continuing. Your event may not be approved without prior consultation

3.2 Briefing before event including Police, Council and Security representations
Select date
Venue of debriefing
3.3 Debriefing before event including Police, Council and Security representations
Select date
Venue of debriefing
4.0 Planning The Event
4.1 Venue Alterations and or Modifications- Internal i.e within the hired premises
Attach copy of planned alterations and or modifications
4.1.1 Venue Alterations and or Modification - External to hired Premises
Attach copy of proposed street closures
4.2 Site Plan
4.2.1 Please select all relevant items listed to be included within your site plan

4.2.2 Have you already attached a completed site plan

Please attach copy of all site plans.

The Site Plan is to be distributed to all Stake Holders as well as displayed in Prominent areas

4.3 Signage - Does the event publicity reinforce messages about safe drinking practices?

4.4 Has a public transport plan been developed for the efficient movement of patrons?

4.5 List the provisions you have made to minimise and monitor the level of noise


4.6 WEATHER - Do you have the following in play as a wet weather contingency plan?


4.7 Food - Do you have copies of food handlers certificates?

Attach Copies here

4.7.1Are quality, affordable and accessible food stalls available to patrons in the different venue areas (including licensed areas)?

4.8 Water - Is drinking water available (free of charge) to all patrons attending the event?

Is the location of the water clearly signposted & marked on maps?

4.10 Toilets



What is the expected number of patrons?

If existing facilities are not adequate, additional portable units must be made available. The Australian Emergency Manual recommends the following as a guide: Toilet facilities for events where alcohol is not available Males Females Patrons WC Urinals Hand Basins WC Hand Basins <500 1 2 2 6 2 <1000 2 4 4 9 4 <2000 4 8 6 12 6 <3000 6 15 10 18 10 <5000 8 25 17 30 17 The above figures may be reduced for short term events as follows: Duration of Event Quantity required 8 hrs plus 100% 6 – 8 hrs 80% 4 – 6 hrs 75% Less than 4 hrs 70% Please note: Where 1 – 200 closet pans plus urinal are required, one wheelchair accessible unisex toilet is required.

I Have read the above information

4.12 Entry and Exit details
Complete the checklist for entrance and exit details:

Provide for supervision, marshalling and exiting crowds

Provide exit and escape routes

Provide access for emergency vehicles

Access for wheel chairs

Separate pedestrians and vehicle traffic

Keep entries clear of all other activities

Ensure barriers, fences, gates and turnstiles are suitable & sufficient

Locate ticket sales and ticket pick-up points in line with, but away from, entrances

Provide sufficient and well-trained staff

Check placement and function of exit signs

Have event staff, security, police, transport authorities and food outlets been informed of patron exit times?

5. Health and Safety
5.1 Security

Has a security firm been contracted?

If yes please provide the following details



Please attach security documentation here, copies of individuals security licences, Security Provider License and Security firm Insurance details.

If No, describe security arrangements.

Event Security will

Commence at: Conclude at:

Conclude at:

Will a police & Liquor Licensing Division briefing & debriefing involving all security personnel be held?

Date before event: Date after event:

Police Officer to be present:

Liquor Licensing Division Officer to be present:

What security arrangements have been made for:

Cash: Asset protection:

Crowd Management:

Prohibited Items:

5.2 First aid and emergency medical services

Who is suppling the first aid service?

Start time: Finish time:

No. of First aid personnel: No. of First aid posts

5.3 Emergency procedures

What is the process to ensure that all event staff, security staff, police & emergency services will be informed of the emergency evacuation plan?

Who is the nominated person to authorise an evacuation?

Contact details during the event:

6 Management of alcohol

6.1 Permit conditions

Please upload copy of Liquor permit.

What arrangements have been made to notify the bar staff of the standard and other conditions of your General Purpose Permit or Public Function Approval?

6.2 BYO and non-BYO events

Has the matter of BYO liquor been discussed with the organising committee and other stakeholders for the event?


6.3 Responsible service of alcohol

How will you tell patrons about alcohol, including that alcohol will not be served to minors and intoxicated patrons? Provide examples.

6.4 Beverage containers
What will be used to serve alcohol
6.5 Trading hours


Select date


Select date


Select date


Select date


Select date


Select date
6.6 Alcohol consumption areas

How many alcohol dispensing and consumption areas will be available?

Dispensing areas

Consumption areas

How will the boundaries of consumption areas be defined?

Please Provide Alcohol Plans for your Facility:
Please Provide Alcohol Plans for your Facility: