Request for use of Pyrotechnics before a proximate audience

Name of person, department, or organization sponsoring the production:

Primary contact name:

Primary contact email:

Primary contact phone:

Date and time of the production:

Exact location of the production:

Please be as specific as possible when it come to explaining the location.

Number and types of pyrotechnic devices and materials to be used:

Person in charge of firing pyrotechnics:

Pyrotechnics license ID (if applicable):

Qualifications/experience of the pyrotechnics operator(s):

Operators experience with these pyrotechnics:

Names and ages of all assistants who will be present:

Explanation of the general responsibilities of the assistants:

Point of on-site assembly of pyrotechnic device(s):

Manner and place of storage for the pyrotechnic materials and device(s):

Certification that the set, scenery, and rigging materials are inherently flame retardant or have been treated to achieve flame retardancy:

Certification that all material worn by performers in the fallout area during the use of pyrotechnic effects shall be inherently flame retardant or has been treated to achieve flame retardancy:

Please attach a diagram of the facility where the production is to be held.

One file only.
50 MB limit.
Allowed types: gif jpg jpeg png bmp eps tif pict psd txt rtf html odf pdf doc docx ppt pptx xls xlsx avi mov mp3 ogg wav bz2 gz sit svg tar zip.

Please attach a copy of the MSDS (material safety data sheet) for the pyrotechnic(s) to be used.

One file only.
50 MB limit.
Allowed types: gif jpg jpeg png bmp eps tif pict psd txt rtf html odf pdf doc docx ppt pptx xls xlsx avi mov mp3 ogg wav bz2 gz sit svg tar zip.