ASSET SERVICES
Form: CA004
APPLICATION FOR RELOCATABLE ACCOMMODATION
DECS sites may be eligible to claim a Furniture / Establishment Grant. Please read the Furniture
Establishment Grant fact sheet for eligibility criteria and the claim process:
http://www.decs.sa.gov.au/docs/documents/1/CA001_FurnEstGrant.pdf
Please return all information including this form to:
Asset Co-ordinator, Relocatable Buildings
Asset Services
Level 11, 31 Flinders Street
Adelaide SA 5000 (Courier: R 11/20)
Office use only
Infra No:
SAMIS Site No:
This form can be completed using Microsoft Word
Site name:
Site no:
Contact no:
Region:
Site leader:
Facilities manager:
Contact no:
Required occupation date (Allow at least 30 weeks):
Reason / Justification of need:
Increased enrolments
Replace existing
JP160, Early Years, Year 3
NAP (New Arrivals Program)
Other – describe:
Building description:
Dual
Other – describe:
GLA (General learning area)
Practical area
Activity area
Learning support area
Other – describe:
Single
Building type / use:
Standard specifications for a single classroom:
1 x split system reverse cycle air conditioner
1 x teacher’s cupboard
1 x white board
Provisions for Smart Board, including
1 x double data / communication point
1 x double general purpose power outlet
4 x pin boards
Carpet & underlay
1 x smoke detector
1 x movement detector
3 x double data / communication points
4 x double general purpose power outlets
1 x single entry door
Optional fittings:
Operable wall for dual building
Wet area
Other – describe:
SAMIS site plan with a preferred location for the new building identified (please attach)
Note: Actual siting will be determined by the facilities manager.
The user is expected to confirm current validity by going to
http://www.decs.sa.gov.au/assetservices
1 of 2
Further comments from site leader:
Endorsement:
Enrolment details:
Mid-year enrolment figures for the past 3 years - from phase 3 in the SEA1056 report:
1.
2.
3.
Site Leader:
/
(signature)
Zone details:
/
(date)
Zoned site
Non-zoned site
Additional accommodation is required due to an increase of enrolments from:
In zone students
Out of zone students
Regional Director:
/
(signature)
/
(date)
OFFICE USE ONLY
Recommendation / Capacity profile / Rationale:
Under Base Brief (M2) Capacity:
Site Capacity:
Complete if funded by any source other than the Relocatable Buildings Program (WRB1)
Project
Account code object
Cost centre
Cost account (as
required)
Furniture / Establishment Grant:
Eligible – application prepared on:
/
/
(date)
by:
(please print name)
Ineligible – reason(s):
 Approved
 Not Approved
Assistant Director, Asset Services:
/
(signature)
The user is expected to confirm current validity by going to
http://www.decs.sa.gov.au/assetservices
/
(date)
2 of 2