Notification of Asbestos Removal

This form is for a licensed asbestos removalist notifying the regulator of licensed asbestos removal work under regulation 466 of the WHS (General) Regulations 2022 or the WHS (Mines) Regulations 2022.

Please do not use this form for offshore oil or gas workplaces, workplaces outside Western Australia, and Commonwealth workplaces (e.g. Department of Defence), unless the notification relates to contractors working on Commonwealth workplaces in WA.

Licence Details

Licence holder name
PCBU/Company/Business if different
ACN
ABN
Licence number	Class A Class B Class A = unrestricted licence holders Class B = restricted licence holders
Licence holder telephone
Licence holder email
Licence holder address
Suburb/Town
Postcode	State WANSWVICSAQLDTASNTACT   WA NSW VIC SA QLD TAS NT ACT
First name of person notifying
Last name of person notifying
Position of person notifying

Yes

No