Road Closure Permit

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Acknowledgement Required

I confirm that this request to obtain a Road Closure Permit complies with Curtin University Land and Traffic By-Laws 2008
I have inspected the workplace, have determined and put into place appropriate control measures to minimise health, safety and operational risks, and I agree to accept full responsibility for these risks.
I have downloaded, read and understood the contents of:
Contactor Safety Handbook
Road Closure Permit Guide

I accept and acknowledge all of the above.

Documents Required

All Road Closure permit requests require the following documents:

Only standard document types accepted. Please name files appropriately.
Combined document file size limit of 14MB.

1. Attach a Traffic Management Plan

2. Attach a Location Plan

3. Attach a Work Methodology

4. Attach a Risk Management Plan

Road Closure - Description

Brief description of intended use and details:

The Curtin project number or project name
(if applicable)

Road Closure - Date and Duration

1 day permit

Multi-day permit

Your Details Your Company's Name

Your Name

Your email address. We send important administration notices to this address

Your Contact Number

Curtin Permit Manager Details

Please Note

This is the person who will be responsible for getting this permit processed.
Please remember to speak with your Curtin Permit Manager about this permit application prior to submitting.
Failure to do so may result in delays in processing your permit application and therefore delay any works you plan to undertake.

Your Curtin Permit Manager name

The information gathered from this form will be sent to this Curtin email address

Your Curtin Permit Manager phone number

Site Contact Details Name of the person who will be on-site during this road closure

Job title of the person who will be on-site during this road closure

Contact number of the person who will be
on-site during this road closure

I confirm that all of the supporting documentation and information contained in this permit request is complete and accurate.

ONLINE PERMITS

Acknowledgement Required

All Road Closure permit requests require the following documents:

Please Note