Environmental Access Request Form

This form is intended for contractors who wish to perform environmental work on areas leased by the Airport Development Group, on behalf of an external party.

This workflow provides additional information requested by the Environment team
Additional information requested:
{{information required by environment}}

This workflow provides additional information requested by the Property team
Additional information requested:
{{information required by property}}

This workflow provides additional information requested by the Airside Management
Additional information requested:
{{information required by airside management}}

Section 1 - Contractor Information

Company Name *

Contact Person *

Phone Number *

Email Address *

Section 2 - Client Information

Client Name *

Client Contact Person *

Client Phone Number *

Client Email Address *

Section 3 - Project Information

Project Name *

Purpose of Access **(e.g., soil sampling, drilling wells, water sampling)

Scope of Works *

Section 4 - Licence Deed Details

Applicable Licence Deed Number *

Licence Deed Execution Date *

Licence Deed Parties *

Section 5 - Access Details

Date and Time (From) *

Date and Time (To) *

Airport Location *

Area *

Coordinates *

Description of Activities *

Please upload a marked up aerial photo showing locations and kmz file *

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Section 6 - Environmental Compliance and Safety

Compliant with DIA’s Environmental Requirements *

YesNo

Compliant with Security Rules *

YesNo

Compliant with Best Practice Industry Standards *

YesNo

Training of Staff in Environmental Procedures *

YesNo

Section 7 - Environmental Impact and Mitigation

Potential Environmental Impact*Describe any possible negative effects the work might have on the environment e.g.: pollution, habitat disruption

Description of the Impact*Provide detailed information about how the work will cause the identified environmental impacts, including the scope and duration of these effects

Mitigation Measures*List the steps that will be taken to minimise or prevent the environmental impacts described

Section 8 - Additional Information

Special Requirements or Considerations (if any)

Section 9 - Declaration

I declare that the information provided is accurate and that all activities will be conducted in compliance with DIA’s Environmental Requirements, Security Rules, and best practice industry standards. I also confirm that there is a signed Licence Deed in place as detailed in the Licence Deed Confirmation section above, and I agree to abide by the terms and conditions outlined in that Licence Deed. *

Name *

Date

Sign *

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Section 10 - ADG Environment Approval

Approval Status *

ApprovedDeniedRequest for more information

Conditions of Approval *

Are further approval/s required from other departments? *

YesNo

Please select all the departments that need to authorise this application? *

PropertyAirside Management

Reason for Denial *

Information Required *

Comments *

Reviewed By *

Date of Review *

Reviewer's Signature *

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Section 11 - ADG Property Approval

Approval Status Property *

ApprovedDeniedRequest for more information

Reason for Denial *

Information Required *

Comments *

Reviewed By *

Date of Review *

Reviewer's Signature *

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Section 12 - Airside Management Approval

Approval Status Airside Management *

ApprovedDeniedRequest for more information

Reason for Denial *

Information Required *

Comments *

Reviewed By *

Date of Review *

Reviewer's Signature *

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CAPTCHA *

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