Facility Hire Agreement and Insurance Details Parish Facility Hire Agreement and Insurance Details About You Name * First Name Last Name Organisation or Business ABN Email * Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Website About Your Event Usage Type * Personal Commercial or Business Community Group or Organisation Event Description * Hire Frequency * Single Use Ongoing Use * - For Single Use, please indicate the date and time of the event. - For Ongoing Use, please indidcate approximate frequency (eg. weekly on Wednesdays at 2 pm; monthly on first Friday of month at 6.30 pm) Insurance Matters Responsibility * I acknowledge and accept responsibility for the safe custody of the persons and property during the term of the hire or use. I indemnify the Parish, the Anglican Diocese of Grafton and its officers, from and against all actions, suits, claims and demands of whatsoever nature arising out of or in any way concerning the hiring of the facility. Public Liability Arrangements * I have arranged my own Public Liability Insurance, acceptable to the Parish, for the duration of the event (Please upload proof of cover below.) I have not arranged my own Public Liability Insurance. (Please read and accept the terms below.) Public Liability Insurance Waiver By checking this box, I acknowledge that I have not arranged Public Liability Insurance for the duration of the event outlined in the Parish Facility Hire Agreement and understand and accept that I will be personally liable for all actions, suits, claims and demands of whatsoever nature arising out of or in any way concerning the hiring of the facility. In doing so, I indemnify the Anglican Parish of Kempsey, the Anglican Diocese of Grafton and its officers, from and against all actions, suits, claims and demands of whatsoever nature arising out of or in any way concerning the hiring of the facility. I also acknowledge that the Anglican Parish of Kempsey and the Anglican Diocese of Grafton have the right to withdraw the hire, should the level of risk subsequently be identified as higher than low risk. Declaration Hirer Declaration * As the hirer of the nominated facility, I acknowledge that I have read and accept the below obligations: • To abide by any local legislation/regulations regarding public health requirements (eg. COVID-19 Safety Plans) • To pay the hiring charges in the manner and time agreed • To leave the facility in a satisfactory and clean condition (including any black/white boards) • To remove all rubbish • Not to remove anything owned by the Parish from the facility • To lift (not drag) anything moved within the facility and to return items to their original position • Not to use any exhibits or decorations in the facility without the prior agreement of the Parish Representative • To do no damage to the facility, its furniture and furnishings, accessories or environs and to report to the Parish Representative any loss of damage to property and to pay for its repair or replacement • Not to permit smoking within the facility • To switch off all lights, fans, heaters/air conditioners and other electrical equipment (unless otherwise marked) before vacating the facility • To secure windows and doors on vacating the facility • To return any keys to the Parish Representative in the manner agreed • To conclude evening functions to comply with local noise restriction requirements • To create no nuisance during the period of hire, either by way of noise or otherwise so as to inconvenience adjoining owners or occupiers • Not to carry out in, or about the facility, any illegal activity Signature * Please write your full name in signing this agreement. Thank you for your co-operation. We look forward to providing facilities for your event. Risk Management Checklist Risk Management Checklist Risk Management Checklist To hire this facility, you have been asked to complete this Risk Management Checklist, and to apply controls to manage any identified risks. This demonstrates that you have considered all aspects of your event and you can manage it safely. About You Name * First Name Last Name Organisation or Business ABN Email * Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Website About Your Event Type of Event * Date of Event * Start Time of Event * Finish Time of Event * Estimated Number of Attendees * Potential Hazards Faulty or incorrect use of electrical equipment brought in by hirer * Risks include burn injuries, electric shock, electrocution. I agree when using electrical equipment, all electrical leads must be off the ground where possible and not exposed to water. Where possible, electrical leads should have a label to show they have been tested and tagged annually. Fire or gas explosion * Risks include burns or physical injuries. I agree to use cooking facilities in a safe manner, and to keep flammable items away from naked flames. I agree to identify fire extinguisher location and emergency exits. Incorrect manual handling (bending, stretching, lifting etc.) * Risk includes physical injuries I agree to ask for help when moving bulky or heavy items, and to use a trolley where available. Trip hazards which may cause physical injuries * Risks include physical injuries I agree to ensure there are no trip hazards, and to cover or tape cords securely where cords are required along the floor. Use of equipment * Risks include physical injuries to participants and/or spectators I agree to be mindful of any movements or activities happening in the space that may cause injury to others. I agree to identify location of a first aid kit. Poor lighting * Risks include eye strain, fatigue, trips or falls I agree to switch lights on during use and report any concerns. I agree to using an appropriate amount of lighting during use. Incorrect storage, handling and/or food preparation * Risks include food poisoning I agree that hirers and caterers must comply with Australian National Food Standards and Health Regulations. Not applicable to this event. Poor crowd control Risks include anti-social behaviour, personal injury or property damage I agree to adhere to capacity limits for the space hired. I agree for this event, which has a large number of participants (150 or more) to hire security for crowd control. I agree to notify the Police of the event. Not applicable for this event. Lack of responsible service of alcohol * Risks include anti-social behaviour, personal injury or property damage I agree that any persons selling, serving or supplying alcohol will have a Responsible Service of Alcohol Certificate (Please upload below) Not applicable to this event. Excessive noise levels * Risks include hearing problems, tension/stress on participants or surrounding residents and businesses I agree that noise levels will be monitored, with consideration of the time and the surrounding neighbours. Not applicable to this event. Lack of appropriate traffic management * Risks include traffic accident, personal injury or property damage I agree to ensure all necessary traffic approvals are in place where road closures and/or additional parking is required. Please consider if there will be impacts on pedestrian movements. Not applicable to this event. Excess rubbish and waste * Risks include health risks, property damage or personal injury I agree to use rubbish bins provided. I agree that any excess waste will be removed by the hirer. I agree to have my own waste disposal contractor. Not applicable to this event. Other Please list any other risks identified, and the actions to be undertaken to manage these risks below. Suppliers and Contractors Event Coordinator External Catering Musicians Lighting and Sound Security First Aid Contact Person RSA Contact Person Waste Management Ablutions Rides and Attractions Other Declaration Event Notification I have notified the following organisations of the details of my event NSW Police Rural Fire Service Kempsey Shire Council Signature * Please write your full name in signing this agreement. Thank you for your co-operation. We look forward to providing facilities for your event. New Supplier Information New Supplier / Contractor Information About You Primary Contact Name * First Name Last Name Business / Organisation Name ABN Business / Organisation Email * Business / Organisation Phone * (###) ### #### Business / Organisation Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Website ACNC Information Type of Business / Organisation * Bank Details for Payment Account Name * BSB * Account Number * Declaration Signature * The information supplied above is true and correct. Thank you for your co-operation. We look forward to working with you. Invoice Generation Invoice Generation About The Customer Customer Name * First Name Last Name Organisation ABN Email * Telephone Website About The Event Event Description Date MM DD YYYY Supply Information * Please describe services and associated costs below Has Facilities Hire been provided free of charge? * Yes No If no, how much has been charged for Facilities Hire? Total Charge * Your Name Thank you for your submission. Giordano Business Consulting will process your Invoice Generation Form and send it to the customer to collect payment. Important LinksAnglican Diocese of Grafton - Insurance and Risk Anglican Diocese of Grafton - Policies and ProceduresNSW Police - Register Your PartyKempsey Shire Council - Fire PermitsKempsey Shire Council - Waste Disposal Fees
