All Department Structural specifications and notices relevant to this Scheme can be accessed on the Department of
Agriculture, Food and the Marine website at www.agriculture.ie under the heading “Farm Buildings”

DATE STAMP
(For Official Use Only)
ALL INFORMATION MUST BE SUPPLIED AND ALL
SECTIONS COMPLETED.
Applicant Type (complete only one of the following)
Date(s) of Birth
/ /
/ /
PPS/CRO Number(s)
Individual (single applicant)
Partnership
Company
Joint Application (two or more named applicants)
(Mr./Mrs./Ms.)………………
NAME OF APPLICANT(S) ………………………………………………
(Block Capitals)
ADDRESS: …………………………………………………………………
……………………………………………………………………………...
Telephone No.________________________
Mobile No. _______________________
E-mail address:
………………………………………………………………………………
………………………………………………………………………………
COUNTY
………………………………………………………………
Department Identifier(s)
( Herd (s), Flock (s), Cereal (s), Pig
Number (s), other identifier)
…………………………………………………
…………………………………………………
…………………………………………………

(i) Is any part of the holding (owned/leased) in a less favoured area?
(ii) Is any area on the holding designated as a Natura 2000 site?
(iii) Is applicant a Department registered Organic producer?
If yes, please state Department licence number _____________________
(v) Will the proposed investments be carried out on an off-shore island?
(iv) Has other national/EU funding been sought or received, directly or indirectly, for measures and/or actions qualifying for aid under this Scheme?
If yes, please provide details__________________________________
(vi) Is applicant in a Teagasc Milk Production Partnership?
If yes, please supply valid Certificate of Registration and state number of
partners in the partnership? ______________________
(vii) (a) Has applicant declared a minimum of 5 ha under
Single Farm Payment/Area Aid/IACS application?
If yes, please state year ____________________________________
(b) If the answer above is no, but if there is an intensive enterprise on the holding (minimal of 20 units required) competed the following:
Enterprise
Sow Breeding only
Sow Breeding and Finishing
Pigs Finishing only
Broilers
Broiler Breeders
Layers
Turkeys (fattening)
Free Range Egg Production
Mushrooms
Glasshouse crops
Nursery (liner) production
Shrub production (containers)
Ornamental trees, field grown
Rabbits
Total
Production unit
0.8 unit
1.1 unit
6.0 units/100 pig places
3.0 units/1000 bird places
8.0 units/1000 birds
3.0 units/1000 birds
3.0 units/1000 birds
1.5 units/100 birds
20 units per 30 metre tunnel
125 units per hectare
75 units per hectare
50 units per hectare
25 units per hectare
1.0 unit/100 does
Numbers /Hectares Production Units
Required for EU Reporting purposes).
please tick appropriate box(es
Field Crops
Horticulture
Wine
Permanent Crops
Milk
Grazing Livestock (excl Milk)
Pigs
Poultry
Mixed (crops and Livestock)
Other

Farm Safety Equipment
Safety Rails on Silo Walls
Quantity Applicant’s Proposed Cost per investment (excluding VAT but including own labour/machinery, where applicable)
€ linear m
Safety Fencing for external slurry and effluent stores
(including gate)
Solid Cover for External Slurry and Effluent Stores linear m area m 2 item
Safety Covers on External Agitation Points or
Manholes
Replacement of damaged slats (single/twin/gang) or replacement of existing internal agitation point with new gang slats
Replacement of hinged door/sheeted gate with a new sliding door/roller door on agricultural buildings
Removal of end wall of tank and provision of external agitation point
Wiring/Rewiring of existing farm buildings area m 2 area m 2 item area m 2
Yard Lights (min 200W equivalent, either metal halide or LED)
Retrofitting roof clear-sheet (roof light) with safety cages.
Circulation pipe (6”) to allow for agitation of slurry item item
Linear m
Installation of calving gates linear m
Simple aeration systems
Per compressor
Mobile Cattle Crush Unit (min 2.4m long)
Mobile Cattle penning max of 75 linear metres (in combination with a Cattle Handling unit)
Mobile Cattle weighing scales item linear m item
Leg hoist/ lifter item
Head Scoop item item
Mobile specialised sheep spraying equipment on trailer
Mobile specialised sheep spraying equipment without trailer
Portable Sheep Handling Race with wheels (including footbath) 1,2
Portable basic Sheep Handling Race 1,2 item item item
Mobile Sheep weighing facilities item
Mobile Sheep rollover crates item
Mobile Sheep “batch” footbaths item
Mobile Sheep penning max of 75 linear metres (in combination with a S heep H andling unit)
Mobile Sheep Adoption unit front linear m item
Mobile Sheep Adoption unit front with penning item

(Please note that the quantities and proposed cost(s) referred to above will be used by the Department for the purposes of determining the amount of grant paid to the applicant in accordance with paragraph 5 of the
Scheme, should written approval to commence work be issued by the Department).
Yes
Have the provisions of the Safety, Health and Welfare at Work Act 2005 been complied with?
Declaration to be completed by applicant(s);
I/We declare that –
(a) I/We have read and understand the conditions of the Scheme and, to the best of my/our knowledge, all particulars given on this form are correct;
(b) In respect of any payment made to me/us under the Scheme, relevant bank/building society/credit union account details will be provided to the Department to enable such payment to be made by electronic fund transfer.
NOTE: A false or misleading statement may lead to disqualification from the Scheme for two calendar years, liability to refund any aid already paid, and prosecution.
Please also note that aid will not be given for works commenced or equipment purchased before written approval has issued to an applicant.
Signed __________________________ Date ________________
Signed __________________________ Date ________________
Signed __________________________ Date __________________
THIS FORM, FULLY COMPLETED, TOGETHER WITH SUPPORTING DOCUMENTATION
SHOULD BE SUBMITTED TO FARM SAFETY SCHEME, ON-FARM INVESTMENT SCHEMES
DIVISION, DEPARTMENT OF AGRICULTURE, FOOD AND THE MARINE, JOHNSTOWN
CASTLE ESTATE, CO. WEXFORD.
(Please retain copies of all documentation submitted for your own records)

1.
Please complete and enclose this checklist with your application form FSS 1
T ick Relevant Boxes
Completed application form, signed by applicant.
2. Accompanying Documentation
(i) Farm building layout plan (1:100/1:200 / 1:500 Scale) and drawings
- required in the case of fixed investments only
(ii) see paragraph 10 of Scheme for more information.
Teagasc Milk Production Partnership Certificate (if applicable)
(Please retain copies of all documentation submitted for your own records)

Sample application:
Applicant is planning to carry out the following investment work –
Replace damaged slats in slatted house A (animal area 4.5m x 10m = 45m 2 ) and move the agitation point to the outside.
Rewire house A (50 m 2 ) and wire loose house B ( 60 m 2 )
Install three calving gates (2.5m long) in house B
Install two new yard lights
Retrofit four roof clear-sheets (roof light) with safety cages in house B.
Quantity Applicant’s Proposed Cost per investment (excluding
VAT but including own labour/machinery, where applicable)
€
Safety Fencing for external slurry and effluent stores (including gate)
Solid Cover for External Slurry and Effluent Stores
Safety Covers on External Agitation Points or Manholes linear m area m 2
1
item
€405.00
€2,475.00
Replacement of damaged slats (single/twin/gang) and /or replacement of existing internal agitation point with new gang slats
Replacement of hinged door/sheeted gate with a new sliding door/rolling door on agricultural buildings
Removal of end wall of tank and provision of external agitation point
Wiring/Rewiring of existing farm buildings
45 area m 2
110 area m 2 aream 2 item
€700.00
Yard Lights (min 200W equivalent, either metal halide or LED)
Retrofitting roof clear-sheet (roof light) with safety cages.
2
item
4
item
€460.00
€200.00
Circulation pipe (6”) to allow for agitation of slurry
Installation of calving gates
Linear m
7.5 linear m
€1,110.00
Simple aeration systems
Mobile Cattle Crush Unit (min 2.4m long)
Mobile cattle penning max of 75 linear metres (in combination with a cattle handling unit)
Mobile cattle weighing scales
Leg hoist/ lifter
Head Scoop
Mobile specialised sheep spraying equipment on trailer
Mobile specialised sheep spraying equipment without trailer
Portable Sheep Handling Race with wheels (including footbath) 1,2
Portable basic Sheep Handling Race 1,2
Mobile Sheep weighing facilities
Mobile Sheep rollover crates
Mobile Sheep “batch” footbaths
Mobile Sheep penning max of 75 linear metres (in combination with a Sheep Handling unit)
Mobile Sheep Adoption unit front
Mobile Sheep Adoption unit front with penning
Per compressor item linear m item item item item item item item item item item linear m item item