Bulks Transfer Permit

This form is for the purpose of obtaining permission to conduct bulk transfers and to ensure that hazards associated with this work activity are controlled.

Section 1: Applicant Details
Name of Permit Applicant
(person undertaking work onsite)
Company representative/contact filling out permit
(if different to permit applicant)

Section 2: Description of Location and Activity

Section 3: Permit Dates

Section 4: Permit Conditions
Permit Applicant to tick yes, no or NA to the following

Section 5: Permit Applicant Statement of Acknowledgement

I acknowledge the requirements of the Kimberley Ports Authority to identify and control risks and work in a safe manner at all times. I confirm the company I represent/undertaking the work has satisfactory documented safe systems of work in place and that all permits and licences required are current. Once the permit is authorised ensure that step 8 is completed prior to commencement of activity.

Use your mouse or finger to draw your signature above.

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