This section captures comprehensive identification and contact metadata for all primary stakeholders involved in the high-risk performance activity. Accurate information is critical for emergency response coordination and liability traceability.
Venue Legal Entity Name
Venue Full Physical Address including GPS coordinates if applicable
Venue Primary Contact Person for This Event
Venue Contact Direct Phone Number
Venue Contact Email Address
Venue Type Classification
Enclosed Indoor Arena
Open-Air Amphitheater
Convention Center Ballroom
Temporary Structure/Marquee
Historic/Protected Building
Outdoor Festival Grounds
Rooftop/High-Rise Platform
Other
Event Producer Company Legal Name
Event Producer Primary Contact Name
Event Producer Contact Phone
Event Producer Contact Email
Number of Years Event Producer Has Operated High-Risk Events
Stunt Operator/Pyrotechnics Contractor Legal Company Name
Stunt Operator Primary Licensed Technician Name
Stunt Operator License/Registration Number
Stunt Operator License/Registration Expiry Date
Years of Experience for Lead Technician on This Specific Activity Type
Scheduled Performance Date and Start Time
Expected Performance Duration
Expected Audience/Attendee Count During Performance
Detailed Description of Planned High-Risk Activity
Will multiple high-risk activities be performed simultaneously or in sequence?
Describe the sequence, timing intervals, and safety buffers between each activity:
This section verifies compliance with local fire authority regulations and ensures proper storage, handling, and transportation protocols for all pyrotechnic materials and high-risk equipment. Independent verification is mandatory.
Has a formal permit application been submitted to the relevant Fire Marshal or equivalent authority?
Fire Marshal Permit Reference Number
CRITICAL: Permit application must be submitted and approved prior to performance. This form cannot proceed without Fire Marshal approval.
Fire Marshal Permit Issue Date
Fire Marshal Permit Expiry Date
Upload Certified Copy of Fire Marshal Permit
Will pyrotechnic materials be stored on-site before or after the performance?
Specify Storage Location within Venue Property including building/room designation:
Is the storage facility a certified magazine or licensed hazardous materials locker?
WARNING: Non-certified storage requires immediate Fire Marshal inspection and written exemption. Performance cannot proceed without compliant storage.
Storage Facility Certification Number
Upload Current Storage Facility Inspection Certificate
Are stored materials under 24/7 security surveillance and access control?
Describe alternative security arrangements and justify why 24/7 surveillance is not feasible:
Pyrotechnic Materials Inventory & Classification
Material Name | UN Classification Code | Net Explosive Quantity (NEQ) in kg | Intended Use (Effect Type) | Arrival Date/Time at Venue | Departure Date/Time from Venue | ||
|---|---|---|---|---|---|---|---|
A | B | C | D | E | F | ||
1 | Indoor Stage Flash Powder | UN0431 | 0.5 | Concussion Effect | 7/14/2025, 8:00 AM | 7/14/2025, 10:00 PM | |
2 | Aerial Shells 3-inch | UN0333 | 2 | Finale Display | 7/14/2025, 6:00 PM | 7/14/2025, 11:30 PM | |
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Has a licensed hazardous materials transportation carrier been contracted for material delivery and removal?
Explain transportation method and how compliance with dangerous goods regulations is ensured:
Upload Transportation Carrier License and Insurance Certificate
Will any pyrotechnic materials remain on-site overnight?
I confirm that overnight storage has explicit written approval from Fire Marshal and venue insurer
Have all venue staff who may access storage areas received hazardous materials awareness training?
Specify training plan and completion timeline before event:
This section establishes critical safety perimeters and emergency response protocols. All measurements must be verified by licensed professionals and documented with site-specific diagrams. The exclusion zone must account for worst-case scenario projections including projectile trajectory, blast overpressure, toxic fume dispersion, and drone swarm failure modes.
Has a licensed blast consultant or explosives engineer calculated the exclusion zone?
CRITICAL: Professional exclusion zone calculation is mandatory. Performance cannot be approved without certified blast radius analysis.
Upload Certified Blast Radius Calculation Report
Describe the Primary Exclusion Zone Boundary including reference points and physical barriers:
Minimum Distance from Performance Zone to Nearest Audience Member (in meters)
Minimum Distance from Performance Zone to Nearest Structure or Building (in meters)
Does the exclusion zone intersect with any public rights-of-way, neighboring properties, or inaccessible areas?
Detail mitigation measures including neighbor notifications, temporary closures, or additional security:
Has the exclusion zone been physically demarcated with certified blast-proof barriers or safety netting?
Explain alternative demarcation methods and how effectiveness will be monitored during event:
Number of Trained Safety Marshals Assigned to Exclusion Zone Perimeter
Are emergency shutdown switches or kill-switches accessible to Safety Marshals around the perimeter?
Describe alternative emergency termination procedures:
Emergency Suppression & Fire Safety Contingency
Is a dedicated fire suppression team on standby during the performance?
Number of Fire Suppression Personnel on Standby
Justify why dedicated suppression team is not required and describe alternative fire response protocol:
Number of Fire Extinguishers (Type A, B, C) Positioned within 15m of Performance Area
Number of Pressurized Water Hose Reels within 30m of Performance Area
Are smoke detection or aspirating smoke detection systems active in the performance area?
Will these systems be temporarily disabled or set to 'Performance Mode' during the show?
Detail the fire watch protocol when detection systems are suppressed and the approval from fire authority:
Select all emergency response teams that have been notified and placed on heightened alert:
Local Fire Department
Emergency Medical Services
Hazardous Materials Response Team
Building Security
Neighboring Facility Managers
None of the above
Describe the Emergency Evacuation Trigger Protocol including who has authority to order evacuation:
Is a dedicated on-site ambulance or medical team required based on risk assessment?
Medical Team Provider Name and Certification Level
Emergency Communication Chain of Command
Role/Position | Name | Contact Method 1 | Contact Method 2 | On-Site During Event? | ||
|---|---|---|---|---|---|---|
A | B | C | D | E | ||
1 | Venue Risk Manager | Alex Rivera | Radio Channel 3 | +1-555-0100 | Yes | |
2 | Lead Pyrotechnician | Michael Chen | Radio Channel 3 | +1-555-0101 | Yes | |
3 | Fire Marshal Liaison | Captain David Lee | Direct Line | +1-555-0199 | ||
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Upload Site-Specific Emergency Response Plan Diagram (showing zones, exits, equipment locations)
This section conducts a thorough audit of financial protection mechanisms and legal liability allocations. All insurance policies must be current, event-specific, and include all relevant parties as additional insureds. Failure to meet insurance requirements is automatic grounds for permit denial.
Event Producer General Liability Insurance Provider
Policy Number
General Liability Coverage Limit per Occurrence
General Liability Aggregate Limit
Policy Expiry Date
Does the policy specifically cover pyrotechnics, explosives, or aerial drone operations?
CRITICAL: Standard general liability policies typically exclude high-risk activities. A specialized rider or separate policy is required. Permit cannot be approved without confirmed coverage.
Is the Venue Legal Entity named as an Additional Insured on the policy?
Explain why Additional Insured status is not provided and describe alternative risk transfer mechanism:
Does the policy include a waiver of subrogation in favor of the Venue?
WARNING: Absence of waiver of subrogation may allow insurer to subrogate against venue. This increases venue risk exposure.
Upload Certificate of Insurance (COI) with Additional Insured Endorsement
Stunt Operator/Pyrotechnics Contractor Insurance Provider
Stunt Operator Professional Liability Coverage Limit
Does Stunt Operator carry specialized explosives or drone liability insurance?
Specialized Coverage Limit
Upload Stunt Operator Certificate of Insurance
Are there any sub-contractors involved (e.g., drone pilots, rigging specialists)?
Sub-Contractor Insurance Verification
Sub-Contractor Company Name | Service Provided | Liability Coverage Limit | Additional Insured Endorsement Provided? | COI Document | ||
|---|---|---|---|---|---|---|
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Does the Event Producer maintain Active Shooter/Hostile Event Insurance or similar catastrophic event coverage?
Note: While not mandatory, such coverage is increasingly recommended for large corporate gatherings with high-profile attendees.
Describe the Indemnification and Hold Harmless Agreement structure between Venue, Event Producer, and Stunt Operator:
Upload Executed Tripartite Indemnification Agreement
Has the venue's own insurance carrier been notified of this high-risk activity and provided their written acknowledgment?
CRITICAL: Failure to notify venue insurer may void coverage. Written acknowledgment from insurer is required before permit issuance.
Venue Insurance Carrier Name
Venue Insurance Broker Contact Name
Broker Contact Phone
Upload Venue Insurer Acknowledgment Letter or Endorsement
Have any insurance claims or incidents occurred with this Event Producer or Stunt Operator in the past 5 years?
Provide detailed incident description, claim amount, and resolution status:
This final section requires joint physical inspection and sign-off by the Venue's Risk Management and Building Engineering leadership. Both parties must independently verify that all preceding requirements have been met, that structural integrity is confirmed, and that residual risks are within acceptable tolerance levels. Electronic signatures are not permitted; wet signatures with timestamps are mandatory.
Has the Venue Risk Manager reviewed all documentation in Sections 1-4?
PERMIT ON HOLD: Complete documentation review is prerequisite for sign-off. Return to previous sections.
Has a physical joint site inspection been conducted within 48 hours of the scheduled performance?
CRITICAL: Pre-event joint inspection is mandatory. Schedule inspection immediately.
Joint Site Inspection Date and Time
Upload Joint Inspection Checklist with Photographic Evidence
Risk Manager Pre-Sign-off Verification Checklist
Not Verified | Partially Verified | Fully Verified | Verified with Concerns | |
|---|---|---|---|---|
Fire Marshal permit is valid and covers all planned activities | ||||
Insurance certificates are current and list venue as additional insured | ||||
Exclusion zone calculations are certified and physically verified | ||||
Emergency response teams are notified and confirmed available | ||||
Pyrotechnic storage meets all safety standards | ||||
All follow-up actions from previous assessments are closed |
Does the Chief Building Engineer confirm that the venue structure can withstand anticipated forces (vibration, overpressure, heat flux)?
Detail structural concerns and required remediation:
Chief Building Engineer Name
Professional Engineer License Number
Are there any conditions or restrictions that must be imposed on the performance (e.g., reduced NEQ, increased standoff distance)?
List all conditional requirements and operational restrictions:
Is a post-performance damage inspection required?
Scheduled Post-Event Inspection Date/Time
Overall Residual Risk Assessment (as determined by Risk Manager)
Extreme Risk - Do Not Proceed
High Risk - Conditional Approval Only
Medium Risk - Enhanced Monitoring Required
Low Risk - Standard Protocols Sufficient
Minimal Risk - Within Normal Operations
Venue Risk Manager Signature
Risk Manager Sign-off Timestamp
Chief Building Engineer Signature
Building Engineer Sign-off Timestamp
Do both signatories approve this permit for issuance?
Document reasons for denial and required corrective actions for resubmission:
To configure an element, select it on the form.