Health, Safety and Environment
HSEF0914.3 – Waste Disposal / Recycling Form
Approved by: WHS & HSE Systems Manager
Revision: 2
Date: Jun 2015
Page 1 of 1
Form variations to suit user, system / software constraints, legal requirements or corporate requirements are permissible, as
long as the intent of the form is not compromised.
SITE LOCATION /
PROJECT
Plan Owner(s):
Revision:
Plan Approved by:
Date:
GENERATED FROM:
DESCRIBE WASTE /
RECYCLING
BY WHOM:
DESCRIBE MATERIAL:
IS IT CONTROLLED  YES - If yes, a Permit may be required from EPA
WASTE?
please check with the Environmental Advisor
For more information on Controlled Waste refer to
HSEP0914 –Waste Management Procedure
 NO
QUANTITY
(kg, L, m3)
WASTES
HOW IS IT STORED?
e.g. bags, drums etc.
DISPOSAL METHOD
 DISPOSED AS
WASTE*
 RECYCLED
 RE-USED
PROVIDE DISPOSAL SITE NAME (LANDFILL NAME / PERSONS NAME AND
LOCATION)
*DISPOSAL
LOCATION
SIGNATURE
SIGNATURE
POSITION
DATE :
PRINT NAME:
COMMENTS
(IF ANY)
ADMINISTATION: A copy of the form must be retained with project / job ticket documentation and a
copy must be sent to the Environmental Advisor for sustainability / waste reporting
CAUTION: Printed Document is UnControlled
Print Date: 12/02/2016