Item 6.Research Permit Application.pdf

Research Permit Application Form
A permit to conduct research in Wel ington City Council land.
Send your completed applications to:[email address]
For more information, phone 04 499 4444
When you submit your application, we request that you rename the file using a date-name-location-permit format.
Eg. 20190105-JohnDoe-Makara-permit.pdf

Important:
Kia Ora, thank you for your interest in conducting research in Wellington City’s open spaces, coast, gardens, parks and reserves.
Fill in this form if you intend to conduct a research project and/or other research activities. If you are col ecting materials for non-
research purposes, you should fil  in the collection form instead.
To expedite the process, please ensure that you have filled in all relevant sections, provided adequate information and attached all
relevant documents.
If all required information and documentation is provided, we aim to process applications within a fortnight (2 weeks). If we require
further information or there is additional complexity to the project, such as new sites needing to be identified, a longer timeframe
may be required. To avoid any delays to your project we encourage you to apply as early as possible.
Please note: if the information provided is insufficient, we may request further information, and this may result in delays.
Be aware that additional permits may be required for the proposed activity that the responsibility for procuring these permits lies
with the applicant.

1.  Applicant Details
Full name7(2)(a)
Address:
7(2)(a)

Phone:
7(2)(a)
Email:
7(2)(a)
If you are affiliated with an organisation (school, cultural group, private company, etc.), please fill in the following section
Organisation:
Forest & Bird, Wellington Branch
Type of Organisation:
NGO
Organisation address:
Forest & Bird National Office
Ground floor, 205 Victoria Street, Te Aro, Wellington

PO Box 631 Wellington, 6011
Contact Person:
7(2)(a)
Phone:
7(2)(a)
Email:
7(2)(a)

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2.  Research Details
a)  Purpose of the research activity: (tick all that apply)
☐ Educational ☐ Commercial   ☐ Cultural   ☐
■ Conservation    ☐ Other: ________________________________
b)  Briefly describe the proposed activity. If you have one, please attach your research proposal

Forest & Bird has a mission to improve the biodiversity of nature in New Zealand. The activity being undertaken in Te Kopahou is part
of a broader commitment that the Wellington Branch has to restore biodiversity in the Outer Green Belt.

  This is not a scientific exercise and there will be no samples or any other interference with the flora or fauna in Te Kopahou. The
purpose of visiting the Te Kopahou reserve is to get a better understanding of the overall condition of the site and provide us with data

that we can use to form an opinion on how the biodiversity might improve over the long term and the possibilities for that
improvement.

c)  Preferred Dates: (dd/mm/yyyy) to (dd/mm/yyyy)
From:
09/03/2023                                  To:
30/06/2023
d)  Alternative Dates: (dd/mm/yyyy) to (dd/mm/yyyy)
From:                                                    To:
e)  Frequency of the activity:
infrequent, maybe once or twice a month
a)  Have you received a Wel ington City Council permit for this activity in the past?
☐ YES  ☐
■ NO
b)  If YES, when did you receive that permit?

f)  Names and qualifications of the people involved in the proposed activity: (e.g. Walt Moody, PhD Ecology; 2 volunteers with 5
years of mist netting experience).
7(2)(a)
7(2)(a)

7(2)(a)

g)  List any additional permits you require and whether they have already been acquired: (e.g. DoC endangered species permit,
submitted and awaiting outcome)

h)  What iwi consultation or engagement have you undertaken?
Some informal discussion with members of iwi at Zealandia but no formal iwi engagement has been undertaken. Our investigation is
preparatory and anticipates a more formal and structured engagement at some point with iwi, hopefully in the near future with Council.

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i)
Do you require council support or special access? (e.g. off-road vehicle access)

7(2)(a)
7(2)(a)

j)
Wil  you be adding any new structures, fittings, markings or other permanent or semi-permanent features? (e.g. transect tapes,
tree markings, etc.) Please include their distinct features (e.g. purple and yellow transect markings, X branded camera traps)

There will be no structures or markings, our visits will be purely observation and photographs

3.  Location Details
c)  Do you have a specific location required for your activity?
☐
■ YES  ☐ NO
If NO, consider emailing us at [email address] to discuss possible locations.
a)  Which sector(s) will the activity be located? (Refer to attached map for details)
☐ Northern Sector   ☐ Western Sector   ☐ Central/Town Belt   ☐ Coastal 1 (Evan’s Bay-Miramar-Lyall Bay)
☐
■ Coastal 2 (Te Reikaihau Point to Sinclair Head)   ☐ Botanic Gardens   ☐ Otari-Wilton’s Bush
d)  Describe the preferred location of proposed activity: (please attach a map)

Te Kopahou reserve

e)  Describe an alternative location where the activity could be undertaken: (please attach a map)

N/A

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4.  Collection Details
If you intend to collect any specimens or materials fill this section, if no collection is involved in your activity then skip to
section 5
Please note: Samples must not be taken from biological y sensitive areas or in quantities that would unduly deplete the population
or damage any other ecological associations. At all times, the amount of material to be collected must be kept to a minimum, less
than 10% of any fruit, seeds, leaves or other material from any individual plant.
For some species, further restrictions may apply
a)  Material to be collected: (tick all applicable)
☐ Native Plants  ☐ Exotic Plants  ☐ Invertebrates  ☐ Exotic Wildlife  ☐ DNA samples  ☐ Rocks  ☐ Soil
☐
■ Other(s) : ___________
no
_______
material of
___
any  ____
sort is  ___
to  ____
be
_____
collected ____
b)  Specifics of the material to be collected: (attach a separate sheet if necessary)
Name of Material
Type of Material
Quantity
Collection site
e.g. Harakeke (Flax)
Leaves
10
Otari-Wilton’s Bush

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5.  Effects and mitigation
All activities have effects. In the fol owing section, please describe the actual and potential effects of your proposed activity on our
shared environment.
Where you identify any actual or possible adverse effects, outline strategies you propose to avoid, remedy or mitigate those effects.
(E.g. Weeds may be introduced into the area via sampling equipment. Proposed mitigation: Washing all sampling equipment before
arriving at sampling area.) If you require more space, please attach a separate sheet of paper.
a)  Effects on the subject(s) of your research.
There are no effects that we can envisage as we are using existing tracks and making observations from these tracks. There may be
occasions for us to walk off track a few metres to observe/investigate a location.

Mitigation or avoidance:
We will check and clean our clothing, footwear and equipment to avoid introducing undesirable seed and any other organic material
before each visit. If we move off formed tracks we will take care to avoid walking on or damaging plants. We won't walk anywhere

where there is a chance of disturbing loose material.

b)  Effects on waterways, including streams, lakes, or coastal waters.

None,

Mitigation or avoidance:

We will stay out of waterways, walking boots and clothing will be cleaned before each trip .

c)  Effects on native vegetation, and/or amenity planting.

None

Mitigation or avoidance:

We will avoid interfering with vegetation

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d)  Effects on soils, rocks or other abiotic features.

None that we can envisage

Mitigation or avoidance:
We will keep to formed tracks for the majority of our visits and any off-track digression will be minimal and close to the track. We will
not knowingly walk on ground cover plants and will avoid walking on loose unstable ground

e)  Effects on wildlife, habitats or other biotic features.

None that we can envisage

Mitigation or avoidance:
  Be alert to the presence of wildlife (particularly lizards) and avoid disturbing it by keeping to tracks and remaining at a distance

f)  Effects on fencing, tracks or any other public assets:

None

Mitigation or avoidance:

g)  Effects on other users of the site, including visitors, staff, etc.

None

Mitigation or avoidance:
We are essentially visitors ourselves and acknowledge other people we might meet. We can wear a F&B hi-vis vest if WCC think it
appropriate.

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h)  Effects on historical, archaeological or cultural sites.

None

Mitigation or avoidance:

These will be avoided and not disturbed

i)
What activities will be visible nearby locations, including from trails or private residences? (e.g. Flag markings visible from the
trail, researchers visible from local houses)
We won't look any different to any other visitor unless we wear a F&B hi vis vest in which case it would draw attention to ourselves.

Mitigation or avoidance:


j)
What sort of noise will this activity generate? Please explain.

Normal conversation

Mitigation or avoidance:

k)  What is the fire risk of this activity? Please explain.

None

Mitigation or avoidance:

We do not smoke and will not carry inflammable substance or equipment

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l)
Could the proposed activity introduce weeds or other invasive species? Please explain.

It would be possible

Mitigation or avoidance:

Clean our gear and clothing including boots as if going to an offshore island

m)  Does the proposed activity have any positive effects on park values (natural and/or historic)? Please explain.
  We hope that the observations and data that we collect will be of value to F&B and Council and contribute to the protection and
enhanced biodiversity of Te Kopahou

6.  Health and Safety
a)  Hazard Management
As a research permit holder, you shall take all reasonable and practicable steps to prevent injury to yourself and others.
We encourage you to contact your local ranger(s) on 04 499 44444. They will inform you of any site dangers of which you must be
aware as well as suggest ways to control the hazards. We also advise you to contact them 24 hours before the start of your activity,
so that they may advise you of any new hazards that have arisen.
In the event of an emergency, contact emergency services by dialling 111. All incidents must be reported to the
Wellington City Council on 04 499 4444.
b)  Have you already engaged with relevant WCC staff about any hazards, dangers and procedures at the
☐
■
proposed location(s)?
YES  ☐ NO
c)  Does your organisation have a Health and Safety Policy that you will be operating under?
☐
■ YES  ☐ NO
d)  Do you or your organisation have a Health and Safety Plan for your proposed activity?
☐
if so, please attach it to this application (if you attach a plan, you may skip section 6.e)
■ YES  ☐ NO
Note:  WCC reserves the right to request further health and safety planning and information if the controls or information are
deemed insufficient to complete the permit process.
e)  Health and Safety Plan
•
Divide each job into its main tasks/steps e.g. site set up, traffic management, aerial work, ground work, pack up, driving to
new site etc.
•
Examine the task/step to identify any possible hazards:
o  associated with carrying out each step
o  created if the task steps are incorrect or not completed
•
Record all hazards you identify
•
Suggest ways to control the hazard.
•
Risk score: Once controls are in place, what is the current risk – based on the combined score from the consequence +
likelihood from the risk matrix?
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Risk Score: (Refer
Description: (How can it
Control: (How do we make it a safe
Hazard: (What is the danger?)
to risk matrix
harm?)
work practice?)
below)
e.g. Sunburn, Sunstroke,
e.g. Working in the shade, wearing a
e.g. Weather – Hot Days
e.g. Low
Dehydration
hat, bringing adequate water

Risk Matrix

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Health and Safety Obligations

I will comply with al  reasonable directions of Wellington City Council relating to health and safety
☐
■
I understand my obligations to myself, any subcontractors and employees under the Health and Safety at Work Act 2015,
and confirm my intention to comply at all times while conducting the activities under this permit on public land.
☐
■
I understand my obligation to report all health and safety incidents including accidents and near misses to Wel ington
☐
■
City Council

I will inform the council about the outcomes of my research/material collection
☐
■

7.  Consultation
Neighbours, other park users, iwi and other interest groups may have a stake in your proposal. Ideally you should consult with them
and discuss the positive and negative aspects and effects of your proposed activity. If you are unsure about groups that may need
to be consulted, please contact the WCC staff member you have been corresponding with for more information.
If you have consulted with any relevant stakeholders, then please list down their names as well as outcomes of the consultation.
List down their feedback, including and concerns and suggestions, as well as your response to that feedback.
Consultee
Organisation/Relationship
Feedback
Response
e.g. He raised concerns about our safety
e.g. Assessed site, and found
e.g. H. Tuwhare
Neighbour
due to steep slopes.
concerns valid.
Suggested we move site 10m North.
Moved site 10 m North.
Tom Mayo
Council Ranger
advised to speak to Henk Louw, Council  meeting organised and advised to

Urban

Ecology Manager
apply
for permit
7(2)(a)
Batch Owner
Supportive of F&B involvement in Te
will provide 4WD support

Kopahou

8.  Applicant Statement
I hereby certify that all the information contained in this application is, to the best of my knowledge, true and correct.
I have read and understand the above terms and conditions and am duly authorised to sign this agreement.
I agree to comply with the conditions and to take all necessary precautions while using Council Reserve, Park, Garden or Open
Spaces.
I understand that my proposal may be subject to additional conditions, outlined in schedule 1.
Name7(2)(a)
Date:
Signature:
7(2)(a)

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Research Permit
A permit to occupy council lands, parks and reserves
for the purpose of research
Wellington City (the Council) hereby grants the applicant a permit for the purposes outlined in the preceding application,
with the sites, dates and conditions specified in schedule 1 of this permit.
Conditions:
1.  The permit holder shall apply to the conditions of this permit at al  times.
2.  The permit holder agrees to pay a collection fee of $100 in advance of the collection activity. This fee is waived if the collection
is conducted for non-commercial research, conservation, education or cultural purposes.
3.  This permit does not confer on the permit-holder any interest in the site(s), nor does it remove any rights of the public to use
and enjoy the whole or any part of the site(s).
4.  The Council may terminate this permit by notice in writing to permit-holder if there are breaches to any of the terms of this
permit or if the activity causes any unforeseen or unacceptable effects.
5.  The permit-holder shall carry out the authorised activity in a safe and reliable way and comply with all statutes, bylaws and
regulations affecting or relating to the land of the activity.
6.  The permit holder acknowledges their safety is their responsibility and they may seek advice from the council in order to
preserve their safety.
7.  In the event of an accident or a near miss accident, the permit holder agrees to report it to the Wellington City Council as soon
as practicable
8.  Only people specifical y named on this permit are authorised to carry out the activity – these rights are non-transferrable.
9.  The permit holder shall not, unless authorised in writing by the Council, interfere with, remove, damage, or endanger the
natural features, animals, plants or historic resources in any area administered by the Council, or bring any plants or animal(s)
to the site(s), or deposit debris, rubbish, or other dangerous or unsightly matter, or contaminate any body of water.
10.  While conducting this activity, the permit holder shall carry this permit with them at all times and must produce it on demand to
Wel ington City Council staff.
11.  The permit-holder should explain to any interested members of the public who observe the activity, the nature of the permit-
holder’s work and that it is being undertaken with special approval.
12.  The permit holder shall not restrict access to any road or track at any time without permission of the relevant site manager.
13.  The activity is to be conducted in the manner directed by the Council away from tracks, picnic areas or areas of high public use
and, as far as practicable, out of sight of the public.
14.  Wherever practicable, access routes to the col ection areas should avoid damage to natural features.
15.  If collecting material from within the col ection areas of a garden, a member of the staff may be required to be present.
16.  The amount of material to be collected must be kept at a minimum at all times. For plant material this is generally restricted to
<10% of available ripe fruit per individual plant, or for cutting material <10% of available suitable cutting material per individual
plant.
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17.  Samples must not be collected from biologically sensitive areas, or in quantities that would unduly deplete the population or
damage any other ecological associations.
18.  The permit holder shall maintain and provide to the Council records of records of col ection sites and materials collected, e.g.
maps of the site(s) used and lists of materials taken from each.
19.  If requested, the permit holder shal  keep the Council and mana whenua informed of the progress of the activity.
20.  After completing the activity, the permit holder shall forward a copy of any research findings, reports and publications to the
Council office that issued this permit. Furthermore, they shal  forward a copy of the species collected, the sites from which they
were collected, any accident or near miss accident reports and any other relevant information.
21.  The permit holder acknowledges that the Council may provide copies of research findings, accident reports, publications and
any other relevant information to mana whenua or other individuals and/or organisations.
22.  No material collected under this permit may be used for commercial purposes or patenting of plant varieties or registration of
intellectual property rights on any derivatives without first getting approval from the Wellington City Council.

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Schedule 1
FOR OFFICE USE ONLY
a)  Do you approve of the people involved in this project?
☐ Yes, as stated by applicant  ☐ Yes, with conditions
[per section 1]
☐ No
Conditions:

☐
b)  Do you approve of the proposed sites?
Yes, with preferred site(s)  ☐ Yes, with alternative site(s)
[per section 3]
☐ Yes, with sites listed below  ☐ No
Conditions:

☐
c)  Do you approve of the proposed dates?
Yes, with preferred dates  ☐ Yes, with alternative dates
[per section 1]
☐ Yes, with entirely new dates  ☐ No
Conditions:

d)  Do you have any other comments or conditions?
☐ Yes  ☐ No
Comments:

Approved by
Date:
Name:
Signature:
Position:
Phone:
Email:

Does this permit require additional approval?
☐ YES  ☐ NO
Additional approval
Date:
Name:
Signature:
Position:
Phone:
Email:

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Health and Safety Guide
For Activities in Wellington City Parks and Reserves

This guide is designed to assist applicants in developing a Health and Safety plan. It provides an overview of some
common hazards encountered while working in reserves as well as procedures with which they may be addressed. This is
NOT a comprehensive list, and your activity will likely involve hazards not listed here.
Potential hazard types
Asset failures
Being near, on or in water
Biological agents
Dust, asbestos and silica
Electrical appliances and internal outlets
Events in Council facilities or on Council-owned land
Excavations
Exposure to criminal activity (theft / vandalism)
Extreme natural events
Firearms
Fixed plant
Hazardous substances
Health and impairment
Helicopters, drones and other powered aerial equipment
Ignition sources
Manual handling
Noise
Other mobile equipment
Personal confrontation
Stacking, racking and material storage
Surface conditions
Tools and equipment
Traffic and pedestrian movement during work activities
Vehicles on/off roads (including bicycles)
Work at Height
Working alone / remote work
Work in confined spaces
Working outside
Work with or in the vicinity of services

TIPS
•
Include site specific hazards eg access to site, weather, ground conditions, public, traffic, other contractors/PCBU’s etc
•
Look for opportunities to eliminate hazards/risks or unnecessary steps.
•
Each hazard must be control ed by working through the hierarchy of control in order (below)
•
Look for ways to improve other aspects, such as quality and productivity, as these things can often help justify costs of making
improvements.

Risk Matrix

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Health and Safety Guide
For Activities in Wellington City Parks and Reserves

Examples of Common Hazards in the Field
Accident procedures
•
Bad weather: check the weather report for the day,
•
In the event of an accident you should have a
wear suitable clothing and be prepared to postpone
suitable first aid kit and mobile phone on hand.
work if needed.
•
If someone is injured:
•
Sharp objects in rubbish: take care when
o  stop work and provide emergency first aid
handling rubbish bags and containers.
and support.
o  call emergency services (111) if
•
Unsafe use of equipment: ensure suitable training
necessary.
on the correct use of equipment. Keep clear of tools
in use; ensure adequate space between tool users.
Call the WCC call centre as soon as practical after the
•
Uneven ground: wear suitable footwear. Use
accident at (04) 499 4444 to report the incident.
caution when navigating terrain.

•
Falling rocks, slippery areas and steep banks:

avoid potential problem areas, choose routes
carefully.
•
Poor lifting technique: lift with your legs and ask
for assistance if required – the safe limit will differ
from person to person but no-one should be lifting
anything heavy without assistance.
•
Water – cold, polluted water or rising streams:
avoid where possible and be prepared to postpone
work if needed.
•
Dangerous vegetation – rotting branches,
poisonous plants (e.g. nettle), etc.: avoid where
possible, report concerns to Wellington City
Council. Check for loose branches above when
working under trees. In high winds, avoid pine and
bush areas. Do not climb trees without proper
equipment, training and PPE
•
Fast moving tides: if working on a beach, check
the tidal reports for the day. Take care and
postpone work if needed.
•
Roads: If working near the road, wear high-visibility
jackets. Take extreme care – if you need to work
within two metres of the road, talk to a park ranger
about road control options.
•
Heat: seek shade, take adequate rest, food and
drink, rotate and share the work load.
•
Fatigue: Take breaks; ensure people aren’t working
for long periods of time. Look out for one another.
•
Beehive or wasp nests: leave the area if a nest or
hive is disturbed; report wasp nests to Wel ington
City Council.
•
Working alone: inform other people about the
specifics of your activity, including where you’re
going, what you intend to do there and when you
plan to return. Have a working mobile phone or
alternative communication device if off site.
•
Neighbours and other passers-by: respect all
neighbours and members of the public, if they
become aggressive or complain about activities
speak with them politely and direct them to contact
WCC at 04 499 4444.
•
People: Ensure anyone under the influence of
drugs or alcohol does not participate. Anyone with
allergies should notify the project leader and carry
personal medication.

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