Form
Wildlife management
Exempt clearing notification (protected plants)
This form is to be used to notify the Department of Environment and Heritage Protection (EHP) of proposed clearing of protected plants that
is exempt under section 261ZA of the Nature Conservation (Wildlife Management) Regulation 2006.
Important information
A protected plant clearing permit is required for clearing protected plants in an area identified as high risk on the
flora survey trigger map, unless an exemption applies. This form is to be used to notify EHP of proposed
clearing that is exempt from the requirement of a permit under section 261ZA of the Nature Conservation
(Wildlife Management) Regulation 2006.
Under section 261ZA, a person may take a protected plant if a flora survey report is submitted to the chief
executive which provides evidence that endangered, vulnerable or near threatened plants are not present in a
clearing impact area, or if these plants are present, that the proposed clearing will avoid the plants by at least
100m. Section 261ZA requires that the flora survey report will be provided at least 1 week before the person
starts clearing, but no later than 12 months after the flora survey was undertaken.
The person giving this notification will receive confirmation of receipt by EHP. Clearing under this exemption
must be conducted within two years after the flora survey report is submitted.
Information you provide in this notification form is required for departmental assessment, compliance and
monitoring purposes. Please refer to the privacy statement at Part 7 of this form.
1. Information regarding the person giving this notification
The chief executive (or their delegate) may use information provided under Parts 2 and 3 to assist in
determining whether they are satisfied that an applicant is a suitable person (s25, Nature Conservation
(Administration) Regulation 2006).
Part 3 applies only to a corporate body with an office in Queensland. Please tick the appropriate box:
AN INDIVIDUAL
Complete Section 2 applicant details — then complete sections 4 to 7
A CORPORATE BODY 
Complete Section 3 applicant details — then complete sections 4
to 7
2. Details for an individual
FAMILY NAME
TITLE
GIVEN NAME/S
DATE OF BIRTH
RESIDENTIAL ADDRESS (NOT A POST OFFICE BOX)
POST CODE
TELEPHONE (BUSINESS HOURS)
MOBILE
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FACSIMILE
ABN 46 640 294 485
Form
Exempt clearing notification (protected plants)
TELEPHONE (AFTER HOURS)
EMAIL
POSTAL ADDRESS (WRITE ‘AS ABOVE’’ IF SAME AS RESIDENTIAL ADDRESS)
POST CODE
3. Details for a corporate body
REGISTERED LEGAL ENTITIY NAME OF THE CORPORATE BODY (NOT A BUSINESS TRADING NAME)
TRADING NAME/S OF THE CORPORATE BODY (IF APPLICABLE)
REGISTERED BUSINESS ADDRESS OF THE CORPORATE BODY (NOT A POST OFFICE BOX)
POST CODE
TELEPHONE NUMBER OF THE CORPORATE BODY (BUSINESS HOURS)
FACSIMILE NUMBER OF THE CORPORATE BODY
EMAIL ADDRESS OF THE CORPORATE BODY
WEBSITE URL OF THE CORPORATE BODY
POSTAL ADDRESS OF THE CORPORATE BODY (WRITE ‘AS ABOVE’ IF SAME AS BUSINESS ADDRESS)
POST CODE
ABN / ACN / AN, OR TITLE AND SECTION OF LEGISLATION UNDER WHICH THE CORPORATE BODY HAS LEGAL STATUS
NAME OF A DIRECTOR OR EXECUTIVE OFFICER OF THE APPLICANT CORPORATE BODY
SIGNATURE OF A DIRECTOR OR EXECUTIVE OFFICER OF THE APPLICANT CORPORATE BODY
DATE
Details of the person nominated to be in charge of the place(s) where the authorised activity is
to be undertaken
NOMINATED PERSON’S FAMILY NAME
NOMINATED PERSON’S TITLE
NOMINATED PERSON’S GIVEN NAME/S
NOMINATED PERSON’S DATE OF
BIRTH
NOMINATED PERSON’S RESIDENTIAL ADDRESS (NOT A POST OFFICE BOX)
POSTCODE
NOMINATED PERSON’S TELEPHONE NUMBER
(BUSINESS HOURS)
NOMINATED PERSON’S MOBILE NUMBER
NOMINATED PERSON’S TELEPHONE NUMBER (AFTER
HOURS)
NOMINATED PERSON’S EMAIL ADDRESS
NOMINATED PERSON’S POSTAL ADRESS (WRITE “AS ABOVE” IF SAME AS RESIDENTIAL ADDRESS)
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NOMINATED PERSON’S FACSIMILE
NUMBER
POSTCODE
Department of Environment and Heritage Protection
Form
Exempt clearing notification (protected plants)
4. Where is the clearing to be conducted?
Please identify area type:
Provide the street address or real property description(s) of the land(s) in which the project is located, and the local
government area. (If you require more space, attach a separate sheet.)
STREET ADDRESS/RPD
LOT
PLAN
LOCAL GOVERNMENT AREA
If possible, provide a specific location within the property, 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
5.
What are the approximate start and completion dates for the project?
NOTE: 1. The flora survey report must be provided at least 1 week before clearing commences.
2. The flora survey must have been undertaken within the previous 12 months from the date of this
notification.
START DATE
END DATE
6. Flora survey requirements
6.1 Flora survey
Has a flora survey been undertaken in the proposed clearing area?
NO
If no, STOP – a flora survey is a requirement of s261ZA and must be undertaken if you propose to proceed.
Please contact a Wildlife officer at your nearest regional EHP office.
YES
If yes, was the flora survey undertaken in accordance with the flora survey guidelines1?
YES
If yes, go to section 6.2 (Results of flora survey), below.
NO
If no, was the flora survey undertaken in accordance with an alternative flora survey methodology that has been
agreed to by the chief executive?
YES
If yes, please attach to this notification your evidence of the chief executive’s agreement. Go to section 6.2
1
See section 253, Nature Conservation (Wildlife Management) Regulation 2006 - the chief executive may, by gazette notice, approve or
make guidelines (the flora survey guidelines) about the conduct of a flora survey.
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Department of Environment and Heritage Protection
Form
Exempt clearing notification (protected plants)
(Results of flora survey), below.
NO
If no, STOP – the alternative flora survey methodology must first be assessed – please contact a Wildlife officer
at your nearest regional EHP office.
6.2 Results of flora survey
Are endangered, vulnerable or near threatened plants present within the clearing impact area?
NO
If no, go to section 6.3 (Flora Survey Report), below.
YES
If yes, will clearing of, or damage to, these plants be avoided by at least 100m?
NO
If no, STOP – this exemption does not apply for this clearing activity and a clearing permit will be required to
take protected plants. Please refer to the EHP website for protected plant clearing permit requirements.
YES
If yes, go to section 6.3 (Flora Survey Report), below.
6.3 Flora survey report
WHEN WAS THE FLORA SURVEY UNDERTAKEN? PLEASE PROVIDE DATE/S:
FLORA SURVEY REPORT COMPLETION DATE:
Note: Under the Nature Conservation (Wildlife Management) Regulation 2006, the results of a flora survey are
to be presented in a flora survey report, prepared in accordance with the flora survey guideline (or as otherwise
agreed), within 12 months of the flora survey being undertaken.
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 exempt clearing notification (protected plants), pursuant to section
261ZA of the Nature Conservation (Wildlife Management) Regulation 2006. Some information may, if required,
be provided to one or more of the Departments of National Parks, Sport and Racing; Agriculture and Fisheries;
or Health in order to investigate any suspected unlawful activity, biosecurity or health issues. Information
regarding the fact that you are exempt pursuant to section 261ZA of the Nature Conservation (Wildlife
Management) Regulation 2006 may be provided to any party upon request. However, 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.
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Department of Environment and Heritage Protection
Form
Exempt clearing notification (protected plants)
Declaration
Note: If you have provided false or misleading information in this form you may be liable to prosecution under
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 in or with this form may be disclosed publicly in accordance
with the Right to Information Act 2009 and the Evidence Act 1977.
NAME OF NOTIFYING PERSON - EITHER AN INDIVIDUAL, OR A DIRECTOR/EXECUTIVE OFFICER
SIGNING FOR THE APPLICANT CORPORATE BODY
SIGNATURE OF NOTIFYING PERSON
DATE
IF YOUR NOTIFICATION IS MADE ON BEHALF OF A CORPORATE BODY, PLEASE INDICATE YOUR POSITION IN THE CORPORATE BODY (DIRECTOR OR EXECUTIVE
OFFICER)
8. Applicant checklist
Notification form completed and signed
Report of flora survey conducted in
accordance with the flora survey guidelines
attached, OR
Report of flora survey, plus evidence of
alternative flora survey methodology that has
been agreed by the chief executive, attached
Privacy statement acknowledged
Please return your completed notification to:
Customer Service Team
Department of Environment and Heritage
Protection
GPO Box 2454
Brisbane Qld 4001
Enquiries: 1300 130 372
Facsimile: (07) 3330 5875
E-mail: [email protected]
A copy of the Nature Conservation (Wildlife Management) Regulation 2006 may be obtained from the Office of
Queensland Parliamentary Counsel website http://www.legislation.qld.gov.au
A copy of the Protected Plants Code of Practice2, the Flora Survey Guidelines – Protected Plants and the
Information sheet – Wildlife authorities and privacy may be obtained from the EHP website
http://www.ehp.qld.gov.au/licences-permits/plants-animals or by contacting the EHP Referral Centre on 1300
130 372.
2
See Schedule 7, Nature Conservation (Administration) Regulation 2006 – Protected Plants Code of Practice means the document called
‘The code of practice for the harvest and use of protected plants’, approved by the chief executive under section 174A of the Nature
Conservation Act and published on the EHP website.
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Department of Environment and Heritage Protection