TFB & Exemption Online Notification Form

Reference No:*

Notification Form for Work During Total Fire Bans and Restricted and Prohibited Burning Periods

Use this form to notify DFES and local governments when undertaking activities under the following conditions:

During a Total Fire Ban (TFB): Activities such as hot work (welding & grinding), road work (grading & bituminising), off-road use of internal combustion engines (over vegetation including grass, bush or stubble e.g. lawn mowing businesses), blasting, gas flaring, and catering (e.g. outdoor catering such as pizza ovens).
With a Valid Exemption: If you hold an exemption issued by DFES under sections 22C or 25A of the Bush Fires Act 1954 allowing work during a TFB or restricted/prohibited burning periods (e.g. hot fire training, smoking ceremonies).
Under a Direction Notice: When acting in accordance with a Direction Notice issued by a Bush Fire Control Officer under Regulation 39C of the Bush Fires Regulations 1954.

This is a notification form, not an exemption application. If you require an exemption, visit dfes.wa.gov.au.

Multiple exemptions and prescribed activities can be selected through this notification form.

For regulatory conditions that must be met while conducting activities, refer to your exemption, the Bush Fires Regulations 1954, or the TFB guidelines on dfes.wa.gov.au.

ONLINE NOTIFICATION FORM

Are you working under an exemption?

Select Yes if you are conducting work under an exemption issued by DFES under section 22C or 25A of the Bush Fires Act 1954 or a Direction Notice under Regulation 39C. You must provide the exemption reference number.
Select No if you are operating under the regulations (e.g., hot work, road work, off-road activity) without a specific exemption.

Are you working under your exemption?*

Select yes if you have been issued an exemption by DFES, you will need to quote the exemption reference number

Exemption correspondence number:

Insert the DFES exemption correspondence number found on the first page of your exemption notice (eg 22/123456)0/50

Will the work or activity take place during a Total Fire Ban?*

YesNo

You do not need to do the notification form. If an exemption is required, please go to Total Fire Ban Exemptions and click on 'Submit an Exemption Application'.

ABN Lookup

Trading Name:

Business/Industry Type:

Select from the list above what business/industry type you operate under

Details of Business/Industry type

If other has been selected provide details of business/industry type above

NOTIFIER CONTACT DETAILS

Notifiers Full Name:

Enter the name of the person completing the form

Notifies Contact Number:

Contact number of the person completing the form

Notifiers Email Address:

Email address of the person completing the form

SITE CONTACT DETAILS

Name of On-site Contact:

On-site Contacts Phone Number:

On-site Contacts Email Address:

Same as above

FIRE DANGER RATING FOR AREA OF OPERATION

What is the current fire danger rating for the local government area where the work will take place? Current fire danger ratings can be found on the Emergency WA website - emergency.wa.gov.au

Fire Danger Rating (FDR)

Select the appropriate fire danger rating for the work or activity site.

Important: If the FDR is Catastrophic, most activities must cease. Refer to the relevant fact sheet on dfes.wa.gov.au or your exemption for additional restrictions.

Select to confirm FDR:

Activities conducted under a DFES-issued exemption (22C/25A) or regulation 39C.(May occur during TFB or Restricted & Prohibited Burning Times (RPBT) subject to exemption conditions. Please select all that apply.)

WORK / ACTIVITY DETAILS

Date of work or activity

Enter the work or activity date

Work or activity start time

Enter the time the work or activity is planned to begin. Minutes

Provide details of the work or activity being conducted.

e.g. clearing of land with a bobcat, driving over vegetation as part of mining exploration activities etc.

Prescribed activities – permitted during a Total Fire Ban (TFB) (no exemption required) (must meet all TFB regulatory conditions – select all that apply)

MANDATORY CONDITIONS - HOT WORK ACTIVITY

Strict conditions apply when carrying out activities involving HOT WORK. Please download the attached document and acknowledge that you have read, understood and agree to abide by all the conditions for the activity.

DFES-BUSHFIREREGULATIONS-FACTSHEET-HotWork.pdf
Hot Work Activity Factsheet

Download: DFES-BUSHFIREREGULATIONS-FACTSHEET-HotWork.pdf

Please confirm that you have read, understood and agree,on behalf of the company, to abide by the mandatory conditions to carry out hotwork activities.

YesNo

MANDATORY CONDITIONS - BLASTING ACTIVITY

Strict conditions apply when carrying out activities involving BLASTING. Please download the attached document and acknowledge that you have read, understood and agree to abide by all the conditions for the activity.

DFES-BUSHFIREREGULATIONS-FACTSHEET-Blasting.pdf
Blasting Activity Factsheet

Download: DFES-BUSHFIREREGULATIONS-FACTSHEET-Blasting.pdf

Please confirm that you have read, understood and agree to abide by the regulations regarding blasting.

YesNo

MANDATORY CONDITIONS - GAS FLARING ACTIVITY

Strict conditions apply when carrying out activities involving GAS FLARING. Please download the attached document and acknowledge that you have read, understood and agree to abide by all the conditions for the activity.

DFES-BUSHFIREREGULATIONS-FACTSHEET-GasFlaring.pdf
Gas Flaring Activity Factsheet

Download: DFES-BUSHFIREREGULATIONS-FACTSHEET-GasFlaring.pdf

Please confirm that you have read, understood, and agree to abide by the conditions to carry out Gas Flaring activities.

YesNo

MANDATORY CONDITIONS - ROAD WORK ACTIVITY

Strict conditions apply when carrying out activities involving ROAD WORK. Please download the attached document and acknowledge that you have read, understood and agree to abide by all the conditions for the activity.

DFES-BUSHFIREREGULATIONS-FACTSHEET-RoadWork.pdf
Road Work Activity Factsheet

Download: DFES-BUSHFIREREGULATIONS-FACTSHEET-RoadWork.pdf

Please confirm that you have read, understood, and agree to abide by the conditions to carry out road work activities.

YesNo

MANDATORY CONDITIONS - OFF-ROAD WORK ACTIVITY

Strict conditions apply when carrying out activities involving OFF-ROAD WORK. Please download the attached document and acknowledge that you have read, understood and agree to abide by all the conditions for the activity.

DFES-BUSHFIREREGULATIONS-FACTSHEET-OFF-Road-Activity.pdf
OFF-Road Activity Factsheet

Download: DFES-BUSHFIREREGULATIONS-FACTSHEET-OFF-Road-Activity.pdf

Please confirm that you have read, understood and agree,on behalf of the company, to abide by the mandatory conditions to carry out off road activities, including checking if the local government has issued a Harvest Vehicle Movement Ban (r.24C)

YesNo

MANDATORY CONDITIONS - CATERING ACTIVITY

Strict conditions apply when carrying out activities involving CATERING. Please download the attached document and acknowledge that you have read, understood and agree to abide by all the conditions for the activity.

DFES-BUSHFIREREGULATIONS-FACTSHEET-Catering.pdf
Catering Activity Factsheet

Download: DFES-BUSHFIREREGULATIONS-FACTSHEET-Catering.pdf

Please confirm that you have read, understood and agree, on behalf of the company, to abide by the mandatory conditions to carry out catering activities.

YesNo

Activity Location

Please select the relevant DFES region and the Local Government Area where the work or activity will be conducted.

If you are unsure of the DFES region, please refer to the attached map for a guidance.

DFES-Regions.pdf Download: DFES-Regions.pdf

DFES Region:

Select Metropolitan LG Areas:

Select Lower South West LG Areas:

Select South West LG Areas:

Select Great Southern LG Areas:

Select Upper Great Southern LG Areas:

Select Goldfields-Midlands LG Areas:

Select Midwest-Gascoyne LG Areas:

Select Pilbara LG Areas:

Select Kimberly LG Areas:

Broome, Shire ofDerby-West Kimberley, Shire ofHalls Creek, Shire ofWyndham-East Kimberley, Shire of

Address/location of work/activity:

Enter the street address or latitude/longitude. If multiple locations may be worked, list them all, note “multiple addresses within [City/Town etc]”, or attach details. For remote sites, include nearest landmark. Avoid SLK references.

ADDITIONAL NOTIFICATION REQUIREMENTS

If the activity is being conducted within 3km of land managed by the Department of Biodiversity, Conservation and Attractions (DBCA) you must notify the relevant DBCA Regional Office between 24 hours and 30 minutes before commencing the activity.

Refer to the attached map for DBCA Regional Office contact details.

DBCADistrictDutyOfficerContacts.pdf

Download: DBCADistrictDutyOfficerContacts.pdf

SUPPORTING DOCUMENTATION (optional)

Attach any relevant supporting documents, for example:

Fire and Emergency Response Plans
Permits
Maps or site plans
Details of work locations

Evidence Documents:

DECLARATION BY NOTIFYING OFFICER

On behalf of the above-mentioned organisation, I agree that the information provided is correct.The Person completing this form has read and understood the work or activity conditions.

PENALTIES

Failure to comply with regulatory requirements during fire restrictions is a serious offence and may result in significant penalties:

During a Total Fire Ban (TFB):

Penalty: $1,000 infringement or up to $25,000 fine and/or 12 months imprisonment.

During Local Government Restricted & Prohibited Burning Times:

Penalty: $250 infringement or up to $10,000 fine.

*

I acknowledge that non-compliance with regulatory requirements during a Total Fire Ban or the local government's restricted and prohibited burning periods constitutes an offence and may lead to substantial penalties.

Declaration Completed by (Full Name):

Date:

Reference No:

Year fetch from here to Generate ID

Separate Date

Please verify that you are human*