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Application for Event Approval - Public Fireworks Display

Name

Company

Phone Number

Email Address

Display Supervisor Details

Display Supervisor in Charge

Display Supervisor with Endorsements

Fireworks Certificate Number

Certificate Expiry Date

Address/Location of Display

Attach Site Plan

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Date of Display

Time of Display

Rain date (if applicable)

Attach Certificate of Insurance - Insurance must be a minimum $5,000,000 (five million) naming the Township of Brock as additional insured

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Proof of Permission obtained from Property Owner

Yes

Size of largest shell to be used

Restrictions: Display Supervisor with endorsements for the following:

Nautical Shells
Shells Larger Than 155mm (6 inches)
Flying Saucers
Unconventional Sites (i.e. barge, rooftop)

Maintaining the perimeter of the danger zone

A. Spectators shall not be permitted within 200 metre fallout zone, and;

Within 100 metres to the side or behind a high level ramp,
Within 45 metres of the side or behind a low level ramp,
Within 35 metres to the side or behind a ground level detonation area.

B. Ramp shall not be permitted within 300 metres of a storage area containing materials that are flammable, explosive and/or toxic, and;

Within 300 metres of institutional buildings such as a hospital or nursing home,
Within 100 metres of motor vehicles.

Confirmation

I hereby certify I have read, understood & will be guided by all the applicable rules & regulations made under the Federal Explosives Act & specific instructions of the fireworks manufacturers for all intended purposes of the display under application.

Forms

Application for Event Approval - Public Fireworks Display

Restrictions: Display Supervisor with endorsements for the following:

Maintaining the perimeter of the danger zone