Intention to Execute Roadworks - Contractor Proforma

NEW ROADS AND STREETWORKS ACT 1991 ("the Act") PART IV SECTION 109
FOR THE PURPOSE OF PLACING, MAINTAINING, ADJUSTING OR REMOVING APPARATUS IN, OR UNDER A ROAD ( INCLUDING EXCAVATING IN OR BORING UNDER THE ROAD )
Contractor Contact Details
Name

First name

Last name
Address

Address Line 1

Address Line 2

City

County

Postcode

Country
Phone (Day)
Phone (Emergency)
Email

Location
Please be as precise as possible giving road name and route number (if known) including town or village name and adjacent house names or numbers.
In the case of new roads give as much information as possible about adjacent or nearby roads. Please also state whether excavations will affect the verge, service strip, footway, carriageway or a combination of these.
Please note that if the road in which the works are proposed to be carried out is not a public road, (not the responsibility of the Ayrshire Roads Alliance for maintenance purposes) then permission will be required from the road manager or the person(s) responsible for that road.
Road Name
Route Number
Address

Address Line 1

Address Line 2

City

County

Postcode

Country
Location Description

Proposed Site Traffic Management
Please provide details of the proposed site traffic management
ContraflowConvoy WorkingGive and Take Traffic ControlHard Shoulder ClosureLane ClosureNo Obstruction on Carriageway or FootwayPortable Traffic SignalsPriority System Traffic ControlRoad ClosureRoad NarrowingSlip ClosureStop / Go Traffic ControlWorks Entirely on Footway

Proposed site Traffic Management Operational
How long will the site traffic management be operational?
Continuously (24 Hours)Off Peak Only

Declaration
I declare that the details I have given are correct to the best of my knowledge.
Yes
General Data Protection Regulation (GDPR)
Under GDPR, we now have to supply data subjects with Privacy Notices that contain significantly more information than previously required under the Data Protection Act 1998. This is in order to meet new requirements about being transparent and providing accessible information to customers/individuals about how you are going to use their personal data so that they are fully informed and are aware of how they can exercise their rights under GDPR.
I hereby confirm that I give permission to the processing of my personal data
Yes
Name

First name

Last name
Date (dd/mm/yyyy)

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