Mobile elevated work platforms

Section 1 – applicant details

Name(Required)

First Last

Company name(Required)

Company address(Required)

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Emergency contact details (if different to above). This information will be available to the public.

Emergency Contact name

First Last

Emergency email

24-hour emergency contact number

Section 2 – reason for the works

Please provide details of the reason for the works and why they need to take place on the public highway(Required)

Section 3 – location

Please detail the proposed location/s. Please provide as much detail as possible(Required)

Section 4 – Type of Mobile Elevated Work Platform (MEWP)

Please provide details as to the type of MEWP being used(Required)

Section 5 – When do you propose to do the works

Start date(Required)

End date(Required)

Start time(Required)

:

End time(Required)

:

Please provide any additional information in relation to the start and end date and timings in the box below.

If your requests relate to multiple locations, please provide as much detail as possible relating to the date and time at each location.

Section 6 – traffic management

Please provide details of the proposed Traffic Management, including provisions for pedestrians. If you are using a Traffic Management company please include their contact details.(Required)

Section 7 – Community funding

If you are a community group, parish or town council and the application relates to a local community event, you may be eligible for a fee reduction or waiver through the Community Enhancement Fund. Applications from organisations participating in the Road Warden Scheme are more likely to be supported.

Would you like to apply for a fee waiver/reduction?

Yes

No

Is your organisation part of our Road Warden Scheme?

Yes

No

Unsure

Section 8 – additional information

Please provide any other additional details which may be relevant to the application

Section 8 – file upload

Please upload the location plan, chapter 8 accreditation and traffic management plan.

Failure to upload the required documents could result in your application being refused and an administration fee incurred.

Drop files here or

Max. file size: 40 MB.

Please tick to confirm the following:(Required)

Select exactly 7 choices.

I have attached a location plan.

I have attached a traffic management plan.

An appropriate risk assessment has been undertaken.

I have public liability insurance that covers the licence period and the activity detailed in this application.

Suitably qualified personnel will place, operate and maintain the MEWP for the required duration of the licence.

I have attached evidence of the necessary chapter 8 accreditation (operative and supervisor) or suitable alternatives.

I have read and agree to the terms and conditions.

Documentation Failure