Filming Permit Application Form (Strathbogie Shire Council)
Please complete and submit this form.
Your Name
*
:
Your Email
*
:
Event Start Date
*
:
Event Name
*
:
Applicant Information
Company/Applicant Name (responsible for the filming)
*
:
Does the company name match the name insured on the Public Liability Insurance
*
:
Yes
No
Contact Details
Your Position/Title
*
:
Your Mobile
*
:
Is the on-site contact on day of filming same as above
*
:
Yes
No (please fill in contact details below)
Name:
Position/Title:
Phone:
Email:
Production Information
Project Name
*
:
Production Type
*
:
Feature Film
TV One-Off or Series
Short Film
Student Film
TVC
Live Stream
Sporting event
Other
If other - please specify:
Proposed Filming Dates
*
:
Alternative filming dates (weather hold/contingency planning)
*
:
Filming times (including bump-in and bump-out times)
*
:
Location Information
Exact location/s of the proposed filming? (Including any privately owned land)
*
:
Please provide a brief summary or synopsis of the scene and/or activities
Number of people on location
Number of cast
*
:
Number of crew
*
:
Number of parking spaces required at the filming location
Number of cars
*
:
Number of trucks
*
:
Number of oversize vehicles (over 7.5m long or over 4.5 tonnes)
*
:
Unit Base
Will the production need a unit base?
*
:
Yes
If yes add your unit base to your site plan/mud map to the attachments at the end of this form
No
Exact location/s of the proposed unit base? (including any privately owned land):
Unit base times (start/finish):
How many car park spaces required at unit base?:
Number of cars:
Number of trucks:
Structures
Will the production erect any temporary structures such as tents or marquees at the unit base?:
Yes
No
If YES: Please provide details of these temporary structures (size, number style):
(Please note: temporary structures need to be secured by weights, not pegs or stakes)
Traffic Management
Will the production require traffic management or pedestrian management?:
Yes
No
(Please note: If the production is disrupting traffic or pedestrian flow a Traffic Management Plan (TMP) or Pedestrian Management Plan (PMP) Incorporating a Risk Management Plan will be required).
Type of activity (e.g. hold & release, road closure):
Name and details of the traffic/safety company who will be supplying the TMP or PMP:
What times will the roads be affected:
Name of the roads affected by the closure/traffic hold:
Details of any large equipment the production will bring to the location:
(E.g. camera cranes, scaffolding, lighting towers.)
Please select if the production will involve any of the following:
firearms/weapons (including imitation)*
*Confirmation of approval from Victoria Police or other state government agencies will be required with this application
amplified music or sound
other safety concerns*
*Confirmation of approval from Victoria Police or other state government agencies will be required with this application
stunts*
*Confirmation of approval from Victoria Police or other state government agencies will be required with this application
may have environmental impact
may cause offense or concern to the public
Provide details of activity:
Will the proposed filming represent the actual location?:
Yes
No
If NO: Please identify the location the filming will represent::
Attachments
Please upload the relevant documentation for your production. If the documentation is unavailable
to be sent at this time please indicate via email the date on which it will be sent.
Please upload the relevant documentation for your production. If the documentation is unavailable <br /> to be sent at this time please indicate via email the date on which it will be sent.
Public liability insurance: Proof of certificate of currency
*
:
Please note: A permit will not be issued without current PLI
Parking application :
For parking cars, trucks, oversized and other essential vehicles.
Please find form at
https://www.strathbogie.vic.gov.au/images/Assets/2019-2020_Consent_for_Works_in_the_Road_Reserve.pdf
Site plan/mud maps: :
Identifies Parking, Traffic control, unit base, where crew are situated and any equipment other than
the normal amount of filming equipment required for the shoot e.g cranes, long dolly, boom lifts,
scissor lifts.
Running Sheet/Schedule
*
:
A document which establishes a chronology, linking times, events and details of filming activities.
Stakeholder communication plan (Public notification letter)
*
:
The purpose of this is to give traders, residents and other interested parties timely written notice in
advance of your proposed filming activities and show how you’ll address their concerns.
Traffic & Pedestrian management plan(s) :
Required if traffic will be slowed, blocked, redirected, or perhaps even distracted. Be certain to
check if you need permits from Victoria Police and VicRoads (attach your copies of their permits in
the ‘Other permits, approvals etc’ section at the end of this form).
Risk management plan or safety plan :
Complete this if a risk management plan isn’t already attached to a traffic management or
pedestrian management plan, or other activities involve risk you need to manage, e.g. trip hazards,
explosives.
Other permits, approvals or filming information (running sheets, schedules) :
Any other permits or approvals we have asked you for. For example Victoria Police, VicRoads, Parks
Victoria, a waste management plan, etc.
Victorian Screen Industry Code of Conduct :
Signature
*
:
Clear
By signing this you agree that all details are correct and you agree to abide by the Victorian Screen Industry Code of Conduct
Submit
SAVE
