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Working on or Near Utilities Application Form Site Details Address Lot Number DP/DPS Undervaluation Details of OwnerDetails of Nominated ContractorNameNameCompanyCompanyPostal AddressPostal AddressPhonePhoneEmailEmailProposed

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Identify the hazards and risks associated with the work being done on or near the area.

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Workers who are required to work in areas where there are risks associated with working on or near the area.

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Working on or near refers to any task or activity that is being carried out in close proximity to a hazard or potential danger, such as working next to live electrical equipment or working at heights.

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Information that must be reported on working on or near includes the nature of the task or activity, the hazards present, the safety precautions taken, and any incidents or near misses that occur.

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