IMPORTANT: Your personal information is protected by law, including the Privacy Act
1988. Important information about the privacy of your personal information is
contained in our Privacy Collection Notice, available at
www.nicnas.gov.au/privacy/app5. You should ensure that you read and understand
the Privacy Collection Notice before completing this form.
Form EIP-1 - Application for Early Introduction Permit (EIP)
Use this form when applying for a permit to allow the early introduction of a chemical under section 30A of the Industrial Chemicals
(Notification and Assessment) Act 1989 in connection with a Standard or Limited Notification.
Do not complete this form if applying for an EIP for a Polymer of Low Concern (PLC).
This application must either:

accompany an application for an assessment certificate, or

follow a previously submitted application for an assessment certificate.
Return to:
Director
NICNAS
GPO Box 58
Sydney NSW 2001
Telephone (02) 8577 8800 / 1800 638 528
Fax (02) 8577 8888
Importer or Manufacturer
Business Name:
ABN:
NICNAS Registration Number:
Business Address:
Postcode:
Postal Address (if same as Business Address, state AS ABOVE):
Postcode:
Contact Name:
Position:
Phone:
Fax:
E-mail:
Technical Contact
Name:
Position:
Company:
Business Address (if different to above):
Postcode:
Postal Address (if same as Business Address, state AS ABOVE):
Postcode:
Phone:
Fax:
E-mail:
Chemical
Chemical name:
Marketing or other name:
CAS number (if known):
-
-
Chemicals that may be eligible for EIP+:
A. Polymer of Low Concern (PLC) – do not complete this form- use Form PLC-1
B. Non-hazardous chemical/polymer
Use the flowcharts below,
C. Chemicals including polymers with number average molecular weight (NAMW) beginning at STEP 1, to
<1000)
assist with your
D. Polymer with NAMW >1000
application
E. Controlled use chemical/polymer
Note – the introduction of the chemical must be consistent with the reasonable protection of occupational health and safety,
public health and the environment.
+
Jan 2014
page 1 of 8
START
STEP 1
No
Classified as hazardous under the Globally Harmonised System for
the Classification and Labelling of Chemicals (GHS)¹?
Yes
No
Dangerous good?
Yes
Is it ONLY for one of the following hazard classes?

Flammable gases, cat. 2

Acute toxicity-oral, cat. 5

Acute toxicity-dermal, cat. 5

Acute toxicity-inhalation, cat. 5

Skin corrosion/irritation, cat. 3

Serious eye damage/eye irritation, cat. 2B

Aspiration hazard, cat. 2

Hazardous to aquatic environment, cat. Acute 1, 2 or 3

Hazardous to aquatic environment, cat. Chronic 1, 2, 3, or 4

Hazardous to ozone layer
Yes
No
Satisfies at least ONE of the following:
 Dissolves in water without dissociation or association and is not surface active and
the partition coefficient (n-octanol/water) at 20° C as (log Pow) does not exceed 3;
 Solubility in water is greater than 1 mg/L;
 the molecular weight (for non-polymers) or number-average molecular weight (for
polymers) is greater than 1,000
No
Yes
No
Does this application form part of a Standard (STD) notification?
Go to
STEP 2
Is the chemical likely to be released into
a natural waterway?
Readily biodegradable? (in accordance with the Ready Biodegradability Test)
No
Yes
Acute toxicity to fish and aquatic invertebrates and algae
(LC50/EC50) is not less than 100 mg/L?
X NOT ELIGIBLE FOR EIP
Go to
STEP 2
No
Yes
No
Go to
STEP 2
Yes
Yes
No
Go to STEP 2
Go to
STEP 2
Readily biodegradable? (in accordance with the Ready Biodegradability Test)
ü May be eligible for EIP:
Non-hazardous chemical/polymer
Yes
Acute toxicity to fish and aquatic invertebrates and algae
(LC50/EC50) is not less than 100 mg/L?
Yes
ü May be eligible for EIP:
Non-hazardous chemical/polymer
No
No
Is the chemical likely to be released into water treatment works from:
 a single site at a quantity exceeding 10 kg/yr?
 all sites at a total quantity exceeding 50 kg/yr?
Yes
No
Go to
STEP 2
ü May be eligible for EIP:
Non-hazardous chemical/polymer
¹GHS means the Globally Harmonised System of Classification and Labelling of Chemicals, 3rd revised edition, published by the United
Nations. Data on the notified chemical/polymer or an accepted close analogue should be available for the following endpoints. If test data is
not available, refer to the list of Structural Alerts for Permit Categories available on the NICNAS website
1) Chemicals (including polymers with a NAMW < 1000)
 acute oral toxicity,
 acute dermal toxicity,
 acute inhalation toxicity (required if vapour pressure is 1.5 kPa or greater; or 25% or more of the particles have a diameter less than 10 μm
diameter; or the chemical is purposely aerosolised during use except where this constitutes a “controlled use”),
 eye irritation,
 sensitisation,
 repeat dose toxicity,
 genotoxicity – bacterial reverse mutation and genotoxicity in vitro.
2) Polymers with a NAMW > 1000 (other than a PLC)
 acute oral toxicity,
 skin irritation,
 genotoxicity – bacterial reverse mutation
Jan 2014
page 2 of 8
START
STEP 2
Select one of the following:
Chemicals (including polymers with a number average
molecular weight (NAMW) less than 1000))
Polymers with NAMW 1000 or greater
Classified as hazardous under the GHS?
Yes
No
ONLY classified as a ‘skin
irritant, category 2’ OR
’eye irritant, category 2A’
has less than 10% (by mass) of molecules with
molecular weight that is less than 500
Dangerous good?
Yes
No
Yes
No
Yes
Go to STEP 3
No
Go toNo
STEP 3
No
Only a Class 3
flammable liquid?
Yes
Acute toxicity to fish and aquatic
invertebrates and algae (LC50/
EC50) is not less than 100 mg/L?
has less than 25% (by mass) of molecules with
molecular weight that is less than 1000
No
Yes (to all species)
Yes
Go to STEP 3
ü May be eligible for EIP:
Low hazardous chemical/polymer
No
X
NOT ELIGIBLE FOR EIP
Satisfies at least ONE of the following low charge density
criteria:
 Is not cationic and not likely to become cationic in an
aquatic environment that has a pH value greater than 4
and less than 9; and/or
 Is a solid that is not soluble or dispersible in water and
is to be used only in its solid phase; and/or
 For a polymer that includes one or more cationic
groups, the total combined functional group equivalent
weight of any cationic group is at least 5000
No
Yes
Go to STEP 3
Does NOT have any of the following hazard classes under GHS:
 Acute toxicity, category 1, 2 or 3
 Skin corrosion, category 1A, 1B or 1C
 Serious eye damage, category 1
 Respiratory sensitisation, category 1A or 1B
 Skin sensitisation, category 1A or 1B
 Germ cell mutagenicity, category 1A, 1B or 2
 Carcinogenicity, category 1A, 1B or 2
 Reproductive toxicity, category 1A, 1B or 2
 Adverse effects on or via lactation
 Specific target organ toxicity-single exposure, category 1 or 2
 Specific target organ toxicity-repeated exposure, category 1 or 2
No
Yes
ü May be eligible for EIP:
Polymer with NAMW ≥ 1000 meeting low
hazardous criteria
Jan 2014
X
NOT ELIGIBLE FOR EIP
page 3 of 8
START
STEP 3
Has any of the following hazard classes under GHS:
 Acute toxicity, category 1, 2 or 3
 Skin corrosion, category 1A, 1B or 1C
 Serious eye damage, category 1
 Respiratory sensitisation, category 1A or 1B
 Skin sensitisation, category 1A or 1B
 Germ cell mutagenicity, category 1A, 1B or 2
 Carcinogenicity, category 1A, 1B or 2
 Reproductive toxicity, category 1A, 1B or 2
 Adverse effects on or via lactation
 Specific target organ toxicity-single exposure, category 1 or 2
 Specific target organ toxicity-repeated exposure, category 1 or 2
Yes
X NOT ELIGIBLE FOR EIP
Yes
X NOT ELIGIBLE FOR EIP
Yes
X NOT ELIGIBLE FOR EIP
Yes
X NOT ELIGIBLE FOR EIP
Yes
X NOT ELIGIBLE FOR EIP
Yes
X NOT ELIGIBLE FOR EIP
Yes
Chemical has
negligible potential
for migration to
groundwater?
No
Acute toxicity to fish and aquatic invertebrates and algae (LC50/
EC50) is equal to or less than 10 mg/L?
No
There is exposure to consumers or the general public inherent in the
proposed manufacturing, processing or uses of the chemical
No
!!
If you select ‘no’, you must
provide details on exposure and
control measures
Worker exposure is likely to occur and engineering controls,
personal protective equipment and/or safe work practices are not
used/not adequately used in the workplace
No
Ambient release to surface water in concentrations greater than 1
part per billion?
No
!!
If you select ‘no’, you must
provide details about the release
of the chemical from use and
disposal
Ambient release to air above 1 microgram per cubic metre (average
annual concentration)?
No
Release to land or landfill?
No
Yes
No
ü May be eligible for EIP:
Controlled use chemical/polymer
Jan 2014
X NOT ELIGIBLE FOR EIP
page 4 of 8
Select the EIP type you wish to apply for:
Non-hazardous chemical/polymer
☐ Complete Section A, B, C, D, E and declaration
Chemicals including polymers with number average molecular
weight (NAMW) <1000
☐ Complete Section A, B, D and declaration
Polymer with NAMW >1000
☐ Complete Section A, C and declaration
Controlled use chemical/polymer
☐ Complete Section A, B, F and declaration
Complete the relevant checklists to ensure that you have provided technical data or information in the Standard (STD) or
Limited (LTD) notification to demonstrate criteria for an EIP. Please provide a reference to the data (e.g. see attachment c) if
applicable.
Section A
Health Effects
Acute oral toxicity
☐
Acute dermal toxicity
☐
Acute inhalation toxicity
☐
Skin irritation
☐
Eye irritation
☐
Skin sensitisation
☐
Repeated dose toxicity
☐
Mutagenicity
☐
Carcinogenicity
☐
Section B
Environmental Effects
Fish, acute toxicity
☐
Daphnia toxicity
☐
Algal toxicity
☐
Ready biodegradability
☐
Section C
Physical/Chemical Properties
Dissociation Constant
☐
Water Solubility
☐
Hydrolysis as a Function of pH
☐
Partition coefficient (n-octanol/water)
☐
For chemicals:
Molecular weight
☐
For polymers:
Number Average Molecular Weight, including % of
molecular weight species below 1000 Da
☐
Jan 2014
page 5 of 8
Section D
Physical and Chemical Properties
Flash Point
☐
Flammability
☐
Autoignition temperature
☐
Explosive properties
☐
Oxidising properties
☐
Section E
Ready biodegradability
☐
Section F
1. What control measures are used to prevent exposure to the public?
Chemical and/or product containing the chemical is not for sale or available to the general public ☐
Other ☐ Describe:
2. What are the possible routes of worker exposure to the chemical during operations, including in the case of
accidents such as splashes and spills? (tick all that apply)
Inhalation ☐
Contact with eyes ☐
Contact with skin ☐
Other ☐ Describe:
3. What control measures will be used to prevent worker exposure to the chemical? (tick all that apply)
Use of automated enclosed systems ☐
Adherence to Code of Practice ☐
Local exhaust ventilation ☐
Gloves ☐
Goggles or safety glasses ☐
Face shield ☐
Respirators e.g. filter respirators ☐
Aprons or overalls ☐
Other ☐ Describe:
4. Describe control measures to prevent ambient release of the chemical/polymer to surface water to less than 1
part per billion during:





Jan 2014
Manufacture
Processing
Use
Cleaning of equipment
Disposal (e.g. landfill) or cleaning of containers and packaging (e.g. empty drums)
page 6 of 8
5. Is the chemical released as a gas at any point the lifecycle, or does it have a vapour pressure greater than or
equal to 0.01 Pa at 20-25°C?
☐No
☐Yes  Describe the control measures to prevent ambient release of the chemical/polymer to air to less than 1
microgram per cubic meter average annual concentration:
6. Will the chemical/polymer be released to land or landfill?
☐ No  Skip to declaration
☐ Yes  Go to Question 7
7. Is the chemical’s adsorption/desorption coefficient (Log Koc) ≤4?
☐ Yes ☐ No
Are there any uncontrolled releases to land? (e.g. outdoor spray application, chemicals incorporated into rubber
tyres, chemicals used by the public in DIY operations such as engine oil changes)
☐Yes ☐No
If you answered yes to any of the above questions, provide justification of how the chemical meets the criterion of
negligible potential for migration to groundwater:
Declaration
It is an offence under Commonwealth law to supply a statement that is false or misleading
I declare that to the best of my knowledge all the information supplied in this form is true, correct and
complete.
Name:
Position:
Signature:
Date:
Payment Advice (please tick box)
Non-hazardous chemical/polymer
☐ Free of charge
Chemicals including polymers with number average molecular
weight (NAMW) <1000
☐ Fee applies*- complete payment details below
Polymer with NAMW >1000
☐ Fee applies*- complete payment details below
Controlled use chemical/polymer
☐ Fee applies*- complete payment details below
* For fee information see http://www.nicnas.gov.au/regulation-and-compliance/fees-and-charges
Jan 2014
page 7 of 8
Electronic Funds Transfer
Payment Date:
Reserve Bank of Australia
London Circuit
Canberra ACT 2600
Please email payment/remittance confirmation to
newchemicals@nicnas.gov.au or fax (02) 8577 8888
BSB: 092-009
Account Number: 11608-5
Account Name: Dept of Health Official Departmental
Receipts and Payments NICNAS Special Account
SWIFT CODE: RSBKAU2S
If payment is being made from an overseas bank, all bank charges/fees are payable by the payer.
Cheque
Cheques are to be made payable to NICNAS in $AUD. Payments are to be mailed to:
NICNAS
GPO Box 58
SYDNEY NSW 2001
AUSTRALIA
Credit Card
Mastercard
Visa
Credit Card Number:
Expiry Date:
Amount:
Print Name:
Authorised Signature:
Jan 2014
page 8 of 8