Application Form
Environmental Protection Act 1994
Application for approval as an auditor for contaminated land
This approved form is to be used by an individual who is applying for approval as an auditor, in order to
undertake the contaminated land audit functions under Section 568(b) of the Environmental Protection
Act 1994 (the Act). This includes individuals who have accreditation or approval as a contaminated land
auditor in another Australian jurisdiction and who are seeking approval through mutual recognition
according to the Mutual Recognition (Queensland) Act 1992. Contaminated land auditor approvals
remain in force for 3 years from the date of issue unless cancelled or suspended before the period ends.
It is essential that, prior to making any application for approval as an auditor, you refer to the draft prescribed
guideline—contaminated land auditors under Chapter 12, Part 3A (Ref: EM1201) and the draft prescribed code
of conduct—code of professional conduct for auditors approved under Chapter 12, Part 3A (EM1202).
GUIDE
1. Applicant details
Please note these
details will be
used for
correspondence
from the
department
Name
Position
Residential or registered business address
Telephone
Facsimile
Mobile telephone
Email
2. Are you seeking mutual recognition of one or more registration(s) or
approval(s) as an auditor for contaminated land held in another
Australian State?
Yes 
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Provide details about your registration(s) or approvals(s) as an
auditor for contaminated land in any other State and specify all of the
ABN 46 640 294 485
Application Form
Application to be a contaminated land auditor
applicable States.
Attach evidence of:


No
each current registration or approval as an auditor for
contaminated land including certified copies of current
appointments or approval certificates
any conditions or limitations associated with each current
registration or approval.
If No, go to Question 6.
Details
3. Have any of your past or present approvals from any of the other
Australian jurisdictions ever been suspended, revoked, cancelled or
renewal declined?
Yes 
Provide details of this occurrence below.
No
Details
4. Are you currently, or have you been, subject to any disciplinary,
criminal or civil proceedings in any other Australian state in relation to
your activities as an auditor?
Yes 
Provide details of the proceedings and outcome below.
No
Details
5. Do you give consent to the making of inquiries and the exchange of
information with the other State authorities regarding your activities as
an auditor, or any other matters relevant to your request for mutual
recognition?
Yes
No 
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This is a requirement for any person seeking mutual recognition of a
registration or approval as an auditor for contaminated land held in
Department of Environment and Heritage Protection
Application Form
Application to be a contaminated land auditor
another Australian state.
6. Do you hold a current certification against one or more of the following
auditor qualification systems?
Yes 
Check the box beside any of the following certifications currently held:
ISO 19011:2003 (Guidelines for quality and/or environmental
management systems auditing) by a Joint Accreditation System of
Australia and New Zealand (JAS-ANZ) accredited organisation to the
level of auditor or above1
Environmental Management System (EM) Auditor Qualification-based
(QB) Certification Scheme2
Institute of Environmental Management and Assessment (IEMA)
Environmental Auditor Register3.
No 
The draft
prescribed
guideline—
contaminated land
auditors under
Chapter 12, Part
3A sets out what
the chief executive
considers to be
relevant
qualifications.
Provide a statement that, if approved, you are willing, to obtain
certification against one of the above-listed auditor qualification
systems. The chief executive (or delegate) may, if your application is
approved, make this a condition of your approval under s.571(b) of the
Act.
7. Can you provide evidence that you have the qualifications relevant to
being able to perform the audit function(s) of a contaminated land
auditor? (Persons seeking mutual recognition are not required to
complete this question. Go to Question 10.)
Yes 
include relevant details in the table below and attach:


No 
a curriculum vitae showing all relevant qualifications, registrations
and certifications held
certified copies of all relevant tertiary qualifications on which the
applicant relies to support approval of his or her application.
You cannot make an application for approval as an auditor for
contaminated land.
Name of degree or post-graduate
qualifications (and major discipline
if relevant)
Institution conferring the
degree
Year of
completion
1
Certification grade of auditor or above will be considered appropriate.
2
Certification of an equivalent grade to ISO 19011:2003 auditor level or above will be considered appropriate.
3
Certification of an equivalent grade to ISO 19011:2003 auditor level or above will be considered appropriate.
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Department of Environment and Heritage Protection
Application Form
Application to be a contaminated land auditor
8. Can you provide evidence that you have the experience relevant to
being able to perform the audit function(s) of a contaminated land
auditor?
Yes 
No 
The draft
prescribed
guideline—
contaminated land
auditors under
Chapter 12, Part
3A sets out who
the chief executive
considers to be a
suitable referee.

Submitted examples of your work that evidence you played a
lead role in the competencies listed in the draft prescribed
guideline—contaminated land auditors under Chapter 12,
Part 3A.

a completed Schedule of Relevant Projects as per
Attachment 1 and in accordance with the requirements of the
draft prescribed guideline—contaminated land auditors under
Chapter 12, Part 3A.
You cannot make an application for approval as an auditor for
contaminated land.
9. Have you obtained a statement from a suitable referee?
Yes 
You must attach a signed and written statement from a referee which
meets the requirements as outlined in the draft prescribed guideline—
contaminated land auditors under Chapter 12, Part 3A.
The referee’s curriculum vitae must also be attached to this application
unless the referee is an auditor approved to perform contaminated land
audit functions in Queensland.
No 
Applicants seeking
to be approved to
undertake
contaminated land
You must include:
 a curriculum vitae showing all relevant experience and
providing an outline of your work history that, as a minimum,
demonstrates that you have been involved in roles related to
contaminated land audit functions for at least 8 out of the
previous 11 years
You cannot make an application to undertake contaminated land audit
functions.
10. Are you a member of an organisation prescribed under Schedule 8 of
the Environmental Protection Regulation 2008?
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Department of Environment and Heritage Protection
Application Form
Application to be a contaminated land auditor
audit functions
must be members
of an organisation
prescribed under
Schedule 8 of the
Environmental
Protection
Regulation 2008.
Yes 
Include relevant details in the table below and attach a copy of your
current membership certificate or a statement of membership issued by
the prescribed organisation.
No 
Provide a statement that, if approved, you are willing to become a
member of an organisation prescribed under Schedule 8 of the
Environmental Protection Regulation 2008.
Name of prescribed organisation
Type of membership
Membership start and end date
11. Do you have demonstrated knowledge of the Act and any other Act
relevant to undertake a contaminated land audit function?
Yes 
Demonstrate your knowledge of the relevant Act/s in an Audit
Application Statement as described in the draft prescribed guideline—
contaminated land auditors under Chapter 12, Part 3A.
No
12. Have you been convicted of any offences under the Act?
If you have been
convicted of an
offence, please
include details of
the offence
including type of
offence, applicable
legislation, the
date of the offence
and any outcomes
of the offence.
Yes 
Provide a statement below which meets the requirements as outlined in
the draft prescribed guideline—contaminated land auditors under Chapter
12, Part 3A.
No
Details
13. Have you been convicted of any offences under another Act involving
misleading or fraudulent conduct?
Yes 
Provide a statement below which meets the requirements as outlined in
the draft prescribed guideline—contaminated land auditors under Chapter
12, Part 3A.
No
Details
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Department of Environment and Heritage Protection
Application Form
Application to be a contaminated land auditor
The dollar value of
your professional
indemnity
insurance must be
no less than
AUD$5 million, but
in any event must
be sufficient to
cover the work
you carry out as
an auditor. Refer
to the draft
prescribed
guideline—
contaminated land
auditors under
Chapter 12, Part
3A for further
information.
14. Do you hold professional indemnity insurance?
Yes 
State your insurer and your level of cover below (minimum $5 million) and
attach a copy of the current certificate of insurance. Confirm that the level
of insurance you hold is sufficient to cover the work you intend to carry out
as an auditor by ticking this box—
No 
Provide a statement that you will, if approved; obtain professional
indemnity insurance to a minimum level of $5 million and otherwise
sufficient to cover the work you intend to carry out as an auditor. The chief
executive (or delegate) may, if your application is approved, make this a
condition of your approval.
Insurer
Level of professional indemnity
insurance
$
All credit card
payments are
made over the
telephone. To pay
by credit card you
will need to
provide contact
details and an
officer will contact
you to process
your payment.
15. Payment of fees (Persons seeking mutual recognition are not required
to pay the application fee, go to Question 16.)
The application fee4 is:
You may pay your fee via cheque, money order or credit card.
Select the payment method below:
Payment by cheque or money order made payable to the Department of Environment
and Heritage Protection (attached).
Please contact me (the applicant) for credit card payment:
Phone number:
Note: The application fee above is non-refundable once the administering authority decides the
application is valid, regardless if the decision is to refuse or approve an application.
16. Declaration
I declare that:

4
The information provided within this application for approval as a contaminated land
auditor is true and correct to the best of my knowledge. I understand that it is an
offence under section 480 of the Act to give to the administering authority or an
authorised person, a document containing information that I know is false, misleading
These are the fees prescribed under Schedule 10, Part 3 of the Environmental Protection Regulation 2008.
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Department of Environment and Heritage Protection
Application Form
Application to be a contaminated land auditor
or incomplete in a material particular.

I understand that failure to provide sufficient information may result in the application
being refused.

I have read and understood the draft prescribed code of conduct—code of professional
conduct for auditors under Chapter 12 Part 3A.

I understand that all information supplied with this application may be disclosed
publicly in accordance with the Right to Information Act 2009 and the
Evidence Act 1977.

I understand that a contaminated land auditor approval remains in force for 3 years
from the date of issue unless cancelled or suspended before the period ends.
Applicant’s name
Applicant’s signature
Date
Please return your completed application to:
Post:
Permit and Licence Management
Department of Environment and Heritage
Protection
GPO Box 2454, BRISBANE QLD 4001
Courier or hand delivery:
Permit and Licence Management
Department of Environment and Heritage
Protection
Level 3, 400 George Street,
BRISBANE QLD 4001
Hours: 8.30 am—5.00 pm business days
Enquiries:
Permit and Licence Management
Phone: 13QGOV (13 74 68)
Fax: (07) 3330 5875
Email: palm@ehp.qld.gov.au
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Department of Environment and Heritage Protection
Application Form
Application to be a contaminated land auditor
Applicant checklist
Application form completed and the declaration signed.
Question 2: Certified copies of any appointments or approvals from another jurisdiction and details of any
conditions is attached (if applicable).
Question 6: Current certification against relevant auditor qualification system is attached or a statement that
you will, if approved; obtain certification.
Question 7: Curriculum vitae and certified copies of each relevant qualification is attached. (Mutual
recognition applicants are not required to complete this question. Go to Question 10.)
Question 8: Work examples and a schedule of relevant projects as per Attachment 1 is attached.
Question 9: Statement from a referee and the referee’s curriculum vitae (if required) is attached.
Question 10: Copy of current membership certificate or a statement of membership issued by the prescribed
organisation is attached or a statement that you will, if approved; obtain membership.
Question 11: Audit Application Statement addressing the information required in the draft prescribed
guideline—auditors under Chapter 12, Part 3A is attached.
Question 14: Copy of the certificate of insurance or a statement that you will, if approved; obtain professional
indemnity insurance to a minimum level of $5 million and otherwise sufficient to cover the work
you intend to carry out as an auditor.
Question 15: Fees paid or enclosed (Mutual recognition applicants are not required to pay the application
fee)
Privacy statement
The department is committed to protecting the privacy, accuracy and security of your personal information
in accordance with the Information Privacy Act 2009. The department is collecting your personal information
to determine your suitability as an auditor under sections 562–74 of the Act. The information will only be
accessed by authorised employees within the department and will not be given to any other person or
agency unless you have given us permission or we are authorised or required by law. However, if your
application is approved, your name, address and ABN/ACN/AN will be disclosed on the Register of
approved auditors which will be publically available on the department’s website. This disclosure is
authorised by section 540(1)(f) of the Act. Additionally, the information supplied on this form may be
disclosed publicly in accordance with the Right to Information Act 2009 and Evidence Act 1977. For queries
about privacy matters email: privacy@ehp.qld.gov.au or telephone: (07) 3330 5436.
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Department of Environment and Heritage Protection
Application Form
Application to be a contaminated land auditor
Attachment 1—Schedule of relevant projects for contaminated land audit functions
(Mutual recognition applicants are not required to complete this schedule.)
This schedule allows the administering authority to collect information as required by the draft prescribed
guideline—auditors under Chapter 12, Part 3A (the guideline). This will be used to assist the administering
authority to make a decision on your application.
You must provide sufficient detail in the form of the schedule below to demonstrate that you have the relevant
experience and/or qualifications to meet the specialist criteria as set out in the guideline. Your schedule must
describe in summary form (but with a reasonable level of detail) at least 5 relevant projects (preferably in
chronological order) in which you have played a lead role in respect of the audit functions applied for. The
schedule should also provide relatively detailed examples of where you have been required to manage and/or
corroborate with experts of other specialisations in the preparation of assessment documentation. You must
attach set examples of your work that evidence you meet the competencies. Statutory reports from other
Australian jurisdictions will be accepted by the department.
Schedule of relevant projects for demonstrated competency
Project start and finish dates
Project name
Project description
<Please include timeframes for project>
Role of applicant in project
Applicant key tasks and
relationship to competencies
required for particular audit
functions
<Please provide at least one example of corroborations with experts of
other specialisations to be included>
Report annexed
<Please provide reports that evidence competency>
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<Please ensure core and desirable competencies relevant to a
particular audit function are clearly identified to assist assessors in
being satisfied about competency requirements>
Department of Environment and Heritage Protection