Request form
Protected plants
Variation of the Flora survey guidelines
Important information for applicants
This form is to be used to process requests for variation from requirements under the Protected Plants - Flora
Survey Guideline (‘Flora survey guideline’) including for (a) a reduced flora survey buffer zone; (b) approval as
a suitably qualified person; or (c) applying to undertake a flora survey using an alternative method.
Section 249(2) of the Nature Conservation (Wildlife Management) Regulation 2006 (‘the Regulation’) enables
the chief executive to agree to a reduced buffer zone in certain circumstances.
The Flora survey guideline requires approval of a ‘suitably qualified person’ if the person does not meet the
identified criteria of relevant professional qualifications or training and a minimum of 5 years’ experience.
Section 257 of the Regulation requires a flora survey and a flora survey report to comply with the Flora survey
guideline. The chief executive can agree to an alternative survey method for carrying out a flora survey report
if the method is determine to be suitable for identifying the presence of endangered, vulnerable or near
threatened (EVNT) plants within an clearing impact area.
The information provided here will enable your application to be processed as prescribed by the Regulation
and guideline. Your application must be assessed and an authority granted by the chief executive before you
can proceed with the proposed activity. Your application may take up to 15 business days to process. This
timeframe can extend if further information is required to assess your application.
If you have queries about how to complete this form correctly or need guidance contact Permit and Licence
Management on 1300 130 372.
Applicant information
An authority may only be granted to an individual or corporation. Please tick the appropriate box:
AN INDIVIDUAL 
Complete Section 1 applicant details — then complete sections 3 to 8
A CORPORATION 
Complete Section 2 applicant details — then complete sections 3 to 8
1. Applicant details for an individual
APPLICANT’S FAMILY NAME
TITLE
APPLICANT’S GIVEN NAME/S
DATE OF BIRTH
RESIDENTIAL ADDRESS (NOT A POST OFFICE BOX)
POST CODE
TELEPHONE (BUSINESS HOURS)
MOBILE
TELEPHONE (AFTER HOURS)
EMAIL
Page 1 of 5 • 150603
FACSIMILE
ABN 46 640 294 485
Request form
Variation of the Flora survey guidelines
POSTAL ADDRESS (WRITE ‘AS ABOVE’’ IF SAME AS RESIDENTIAL ADDRESS)
POST CODE
2. Application details for corporations
REGISTERED LEGAL ENTITIY NAME (NOT A BUSINESS TRADING NAME)
TRADING NAME/S (IF APPLICABLE)
REGISTERED BUSINESS ADDRESS (NOT A POST OFFICE BOX)
POST CODE
TELEPHONE (BUSINESS HOURS)
FACSIMILE
EMAIL
WEBSITE
POSTAL ADDRESS (WRITE ‘AS ABOVE’ IF SAME AS BUSINESS ADDRESS)
POST CODE
ABN / ACN / AN, OR TITLE AND SECTION OF LEGISLATION UNDER WHICH CORPORATION HAS LEGAL STATUS
NAME OF PRINCIPAL OF CORPORATION
SIGNATURE OF PRINCIPAL OF CORPORATION (or person authorised to sign on their behalf)
DATE
Application
Please identify the purpose of the request (please tick the appropriate box):
Flora survey reduced buffer zone  Complete Section 3 — then complete section 6
Registering a suitably qualified personComplete Section 4— then complete section 6
Alternative flora survey method  Complete Section 5 — then complete section 6
3. Flora survey reduced buffer zone
A reduced buffer may be agreed in certain circumstances for example where the buffer zone area falls within
terrain that is inaccessible; a highly modified environment such as a road or residential area (less than
1,000m2); permission for landholder access cannot be secured or other reasons deemed to be reasonable by
the chief executive.
Provide the street address, real property description(s) of the land(s) in which the project is located and local
government area. (If you require more space, attach a separate sheet.)
STREET ADDRESS
Page 2 of 5 • 150603
Department of Environment and Heritage Protection
Request form
Variation of the Flora survey guidelines
If possible, provide a specific location within the property boundaries, a property name or attach a map with the project area clearly
delineated. Also include the map name/details.
SPECIFIC LOCATION/PROPERTY NAME
GEOGRAPHICAL COORDINATES
3(a)
Attachments
For a request to reduce the flora survey buffer zone identified as high risk on the flora survey trigger map,
attachments must include:
a.
copy of flora survey trigger map relating to the application and any other maps
b.
written documentation justifying why a reduced buffer is necessary
c.
a plan with the proposed reduced buffer widths. Note: If the request is considered acceptable, the
submitted plan will be referenced as the approved plan with the decision notice and will be required to
be kept by the applicant as evidence for any future clearing applications.
List all attached documents, including maps containing information supporting this application in the space
below.
ATTACHMENTS (LABEL ALL ATTACHMENTS ALPHABETICALLY E.G. “ATTACHMENT A”)
4. Request for a Suitably Qualified Person
Note: if you are a person that meets the criteria of a suitably qualified person, then you do not need this request.
Evidence will need to be supplied for a person to be considered ‘suitably qualified’ including professional
qualifications or formal training (in plant identification and Queensland flora taxonomy) or other appropriate
training and/or experience in identifying EVNT plants.
4(a)
Attachments
For a request to consider a person as ‘suitably qualified’ who does not currently meet the eligibility criteria in the
Flora survey guidelines, attachments must include:
a.
evidence demonstrating that the persons skills and experience are appropriate to identify EVNT plants
b.
a CV outlining their credentials and referee statements if appropriate.
List all attached documents, including supporting information in the space below.
ATTACHMENTS (LABEL ALL ATTACHMENTS ALPHABETICALLY E.G. “ATTACHMENT A”)
Page 3 of 5 • 150603
Department of Environment and Heritage Protection
Request form
Variation of the Flora survey guidelines
5. Alternative flora survey method
The alternative flora method will need to justify its ability for identifying the presence of EVNT plants. Details of
the location or the activity may be necessary to provide justification that approval of an alternative method is
required.
5(a)
Attachments
For a request for an alternative flora method, attachments must include:
a.
Explanation why an alternative method is required, for example,
i.
ii.
b.
the Flora survey guideline survey methods will not achieve the required outcomes; or
the area contains varying conditions that warrant an alternative method to be used. For example
environmental aspects, type of vegetation communities or the target potential EVNT species.
Justification and outline of the proposed method and evidence that the method is suitable for identifying
the presence of EVNT plants within the clearing impact area. This will need to be prepared by a suitably
qualified person.
List all attached documents, including maps containing information supporting this application in the space
below.
ATTACHMENTS (LABEL ALL ATTACHMENTS ALPHABETICALLY E.G. “ATTACHMENT A”)
6. Declaration
Note: If you have not told the truth in this application you may be liable for prosecution under the relevant Acts
or Regulations.

I do solemnly and sincerely declare that the information provided is true and correct to the best of my
knowledge and I make this solemn declaration conscientiously believing the same to be true.

I understand that all information supplied on or with this application form may be disclosed publicly in
accordance with the Right to Information Act 2009 and the Evidence Act 1977.
APPLICANT’S NAME
APPLICANT’S SIGNATURE
DATE
IF APPLICANT IS A CORPORATION, WHAT IS YOUR POSITION IN THE CORPORATION?
7. Privacy statement
Information you provide on this form is being collected by the Department of Environment and Heritage
Protection to process and administer your request for a variation to the flora survey guidelines (protected plants)
as authorised under the Flora survey guidelines. Some information may be provided to the Department of
Page 4 of 5 • 150603
Department of Environment and Heritage Protection
Request form
Variation of the Flora survey guidelines
National Parks, Recreation, Sport and Racing; Agriculture, Fisheries and Forestry; or Health in order to
investigate allegations of unlawful activity, biosecurity or health issues, if required. Information regarding your
status as a holder of this type of authority may be provided to any party upon request. Your personal information
will not be disclosed to any other parties unless authorised or required by law. More information on our
commitment to privacy is available on our website: http://www.ehp.qld.gov.au/legal/privacy.html.
8. Application checklist
Application form completed and signed
Please return to:
Relevant supporting information including:
Permit and Licence Management
Flora survey trigger map (sections 3 and 5)
Proposed new buffer widths (section 3)
CV of qualifications and/or experience
(section 4)
Justification of alternative flora survey method
(section 5)
Privacy statement acknowledged
Department of Environment and Heritage
Protection
GPO Box 2454
Brisbane Qld 4001
Enquiries: 1300 130 372
Facsimile: (07) 3330 5875
E-mail: palm@ehp.qld.gov.au
The Nature Conservation (Wildlife Management) Regulation 2006 may be obtained from the Office of
Queensland Parliamentary Counsel website http://www.legislation.qld.gov.au
Code of Practice or guidelines may be obtained from the EHP website http://www.ehp.qld.gov.au/ or by
contacting the EHP Referral Centre on 1300 130 372.
Page 5 of 5 • 150603
Department of Environment and Heritage Protection