Adventure Activities Licensing Authority

Application Form

Contents

Statutory Information	2

Licensable activities you wish to provide	3

Section 1: Responsibility for managing health and safety	4

Section 2: Procedures for assessing & controlling risk (risk assessments and/or operating procedures)	4

Section 3: Recruitment, selection & deployment of competent instructors	5

Section 4: Equipment & maintenance of equipment	6

Section 5: Reviewing & monitoring safety arrangements	6

Section 6: Emergency procedures, incidents and first aid	7

Declaration	7

When completing this Application Form, please refer to the guidance document provided.

Statutory Information

Please complete this table to assist with the logging of your information.
Are you applying to renew an existing licence? Yes/No
Current Licence Number – if applying for a renewal	L
Company Reference Number – if applying for a renewal	R
Applicant Details
Who will hold the licence? If this is a company, use the registered company name, company number and registered address of the organisation that is required to hold the licence. If you are applying as an individual, please use your full name as it would appear on a passport or driving licence. Use your home address or the address from which you operate. If you also use a trading name, please include this, e.g. John Smith trading as The Adventure Company. It is important that the licence holder is the legal entity that provides the facilities for the adventure activities (e.g. not an activity centre or an employee of the legal entity). This information will appear on the public register. Please see guidance notes for more information	Full Name
Is this an individual or organisation?
Company number (if a limited company)
Address
Telephone Number
Email address
Website address
If different from the above, who should we contact about this application? .	Contact Name
Position
Telephone Number
Email Address
Address
If the licence relates to a specific activity centre, please provide:	Centre Name
Address
Telephone Number
Website Address

Licensable activities you wish to provide

Activity Category	Trekking	Caving	Climbing	Watersports
Yes/No	Yes/No	Yes/No	Yes/No
Activities you wish to include on your licence
Operating area(s) & description of upper hazard level (eg. North Wales, rivers up to and including grade 2)
Months you intend to operate
Maximum number of participants on activities at any one time

Section 1: Responsibility for managing health and safety

Regulation 6(1)(a)(iv) and 9(1)(c)

Attach acceptable evidence as described in the guidance and/or describe below: Who has overall responsibility for health and safety? Who has day to day responsibility for managing your provision? What are your arrangements to ensure that the management of safety is in the hands of, or effectively advised by, people with sufficient knowledge of safety matters for the activities you intend to provide?
Your Answers:
Please list in the table below any evidence you have submitted for this section. Name of Document (please give exact name) Total number of pages in document

Section 2: Procedures for assessing & controlling risk (risk assessments and/or operating procedures)

Regulation 6(1)(a)(i and ii)) and 9(1)(a) and 9(1)(b)(ii))

Attach acceptable evidence as described in the guidance and/or describe below: What are your arrangements for assessing and managing the risks associated with the activities you deliver? What is the minimum level of competence required of instructors delivering each of the activities you provide? What is the maximum number of participants an instructor may be responsible for in each case? What are your arrangements for providing safety information to instructors and participants?
Your Answers:
Please list in the table below any evidence you have submitted for this section: Name of Document (please give exact name) Total number of pages in document

Section 3: Recruitment, selection & deployment of competent instructors

Regulations 6(1)(a)(iii) and 9(1)(b)(i)

How many instructors do you have?
Number of Employees	Permanent	Seasonal	Occasional /Freelance
Total	Full Time	Part Time	Total	Full Time	Part Time	Total

Attach acceptable evidence as described in the guidance, and/or describe below: How do you make sure all instructors deployed to deliver activities are competent to do so?
Your Answer:
Please list in the table below any evidence you have submitted for this section: Name of Document (please give exact name) Total number of pages in document

Section 4: Equipment & maintenance of equipment

Regulations 6(1)(a)(iii) and 9(1)(b)(iii and iv)

Attach acceptable evidence as described in the guidance and/or describe below: Equipment: How do you ensure the equipment you choose is appropriate? Do you have planned replacement schedules? How do you ensure an adequate supply of different sizes/types of activity equipment to suit users’ needs? Maintenance of Equipment: What is your process for identifying defective or obsolete equipment (how is it isolated to prevent inadvertent use)? How do you ensure equipment remains fit for purpose?
Your Answers:
Please list in the table below any evidence you have submitted for this section: Name of Document (please give exact name) Total number of pages in document

Section 5: Reviewing & monitoring safety arrangements

Regulations 6(1)(a)(iii) and 9(1)(a)

Attach acceptable evidence as described in the guidance and/or describe below: How will you make sure that your safety arrangements remain fit for purpose throughout the duration of your licence?
Your Answer:
Please list in the table below any evidence you have submitted for this section: Name of Document (please give exact name) Total number of pages in document

Section 6: Emergency procedures, incidents and first aid

Regulations 6(1)(a)(iii) and 9(1)b(v)

Attach acceptable evidence as described in the guidance and/or describe below: What are your procedures for dealing with emergencies and the summoning of medical/rescue services? How do you ensure participants have ready access to appropriate first aid? What are your procedures for reporting, recording, investigating, learning lessons from accidents, incidents and near misses?
Your Answers:
Please list in the table below any evidence you have submitted for this section: Name of Document (please give exact name) Total number of pages in document

Declaration

I hereby apply for a licence under the terms of the Adventure Activities Licensing Regulations 2004. I have completed the application form and included the necessary information with it. I understand that my application will not be accepted for processing until all the necessary supporting information has been provided AND the payment has been received by HSE. I understand that once my application has been accepted for processing, no refund can be made. I understand that it is an offence, under regulation 16 of the above, to make a false statement for the purposes of obtaining or holding a licence.

Full Name (block capitals):
Position within the organisation:
Signature:	Date:
On completion please return this application form with the required accompanying documents and continuation sheets to AALA-Applications@hse.gov.uk