NOTIFICATION FORM
Notification of New (Commissioning) Hazardous
Substance Location or Transit Depot
The HSNO Act 1996 and the Hazardous Substances (Classes 1 to 5 Controls) Regulations 2001 (Regulations 30, 77, 83, 94,
101, 116 and 124) require the person in charge of commissioning a hazardous substance location or transit depot to notify an
Enforcement Officer before commissioning. Note: “commissioning” relates only to the hazardous substances located at the site.
Notification time frames
Hazardous Substance Location (excluding LPG) or Transit Depot
At least 30 working days
Hazardous Substance Location (where LPG is to be located)
At least 5 working days
Site and contact details
Company Name (if applicable)
Name of Person in Charge
Company Street Address
Email Address
Daytime Phone Number
Test Certifier (if one is contracted at this time)
Test Certifier’s Contact Phone
Indicate whether the site is a
Does the HS Location relate to a residential property?
Hazardous Substance Location
Transit Depot
Yes
No
Summary of hazardous substances
Substance Class 1 Maximum Quantity
Substance Class 2 Maximum Quantity
Substance Class 3 Maximum Quantity
Substance Class 4 Maximum Quantity
Substance Class 5 Maximum Quantity
If Class 2, LPG?
Yes
No
Ministry of Business, Innovation and Employment (MBIE) contact details
This completed form should be sent to:
The Registrar, Health and Safety Group Response Team, MBIE, PO Box 105146, Auckland
or faxed to 09 984 4115 healthsafety.notification@dol.govt.nz
Date: _________________
www.epa.govt.nz