Safety advice form

To request a Safety Advice from us, please complete the below form.

Please note that should we be required to carry out work, a quotation for this work will be completed and sent to you.

We typically require 10 working days lead time from receipt of payment to complete most requests.

Please ensure you have familiarise yourself with the Electrical Safety Code of Practice 2020 - Working near overhead and underground electric line to understand your obligations and prospective means of meeting them.

Please note: Fields denoted with * are mandatory.

Please view our Privacy Statement regarding the collection of data.

Requested by:

Person responsible for the worksite:

Company name:

ABN:

Business address:

Postal address:

Contact number:

Email address:

Re-enter email address

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Work information

Work industry:

Work type:

Other: Please complete if you selected Other in Work type

Work machinery / Equipment / People:

Details of work being performed:

Address: Enter the location of work being completed

Suburb:

Postcode:

Work commencement date:

Estimated completion date: Please select date or enter in format dd/mm/yyyy

DBYD enquiry / Referral number: Required for Underground Assets

Building or adding to a structure near an electric line Are your proposing to build or change a building or structure or do other work on a building or structure within 5 meters of an electric line?

Please note: Under the Electrical Safety Regulation 2013 section 209 you must provide notification to us before works start on any construction or addition or other work on a building or structure that is likely to come within the clearance requirements under the Electrical Safety Regulation 2013 for an overhead or underground electric line. Any reasonable costs associated with required relocation or modification of our assets will be at the cost of the responsible person.

Authorised persons

Will there be an Energex approved “Authorised Person” on site to receive safety advice? An Energex Authorised Person has fulfilled certain requirements, training and has received an approval letter from us. It is NOT mandatory to receive Safety Advice, if you unsure please select No.

Is the Authorised Person Electrical or Non-Electrical?

Authorised Person’s Name

Authorised Person’s Company of Employment

Authorised Person’s Electrical Licence Number

Attachments (add any relevant attachments)

Click to add attachment 1 Please keep file size under 5MB

Click to add attachment 2 Please keep file size under 5MB

Click to add attachment 3 Please keep file size under 5MB

Click to add attachment 4 Please keep file size under 5MB

Terms and conditions

Electrical Safety Code of Practice 2020: Electrical Safety Codes of Practice

Entity Requirements (PDF 725 KB)

I have obtained a copy of the Electrical Safety Code of Practice 2020 - Working near overhead and underground electric lines and the Entity Requirements document Working near overhead and underground electric lines

Exclusion zones:

I am aware that prior to receiving written Safety Advice all exclusion zones must be maintained and communicated to the Person Responsible for the work site.

Written safety advice:

I am aware that a written Safety Advice will need to be issued in person at the intended work site to the Person Responsible for the work site.

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Safety advice form

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