PlannedWorkRequest

Application for planned work on or near network

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*Denotes mandatory field

Company representative and company details

Company name *

ABN details *

Given name *

Surname *

Daytime contact number *

Email address

On site contact name *

On site contact number *

Work request details

Requirements on day of works # Notification to Evoenergy of works planned near network only
Authorised person to be provided by Evoenergy for standby
De-energisation of Evoenergy assets

# All additional charges as per Evoenergy Schedule of Electrical Network Charges.

Start date *

Start time *

End date *

End time *

Location of work (nearest street address) *

Block *

Section *

Description of Work *

Job site * Single job site Multiple job sites

Applicant declaration

I declare that I and my employees will:

Work in accordance with Evoenergy's Electricity Network Safety Management System and all other relevant operational procedures, including the Electrical Safety Rules.
Conduct hazard and risk assessments at all work sites and implement requirement controls where required.
Report all accidents and incidents.
Comply with Evoenergy's Code of Conduct.
Ensure that my annual safety and mandatory trade refresher training is maintained.
Show any authorisation identification issued to me at Evoenergy's request.

I attest that the listed company and employees are sufficiently competent to undertake the work outlined in this request and agree to make employees aware of Evoenergy's Electricity Network Safety Management System, procedures, and any relevant Acts, Regulations, and Guidelines.
I accept responsibility for work and actions taken by company employees whilst carrying out work on or near Evoenergy's network whilst employed by the accredited body nominated in this application.
I further declare that the above information is true, correct, and current.

I declare that the information contained in this application is correct.

Name *

Position title *

Accompanying documentation

Diagram of site (8 MB file upload size limit)

Attachment can be an Office document or PDF.

Proposed works (8 MB file upload size limit)

Attachment can be an Office document or PDF.