Notification of Particular Hazardous Work

Notification is hereby given under the Health and Safety in Employment Regulations 1995 in respect of the following work:

Fields marked with an * are required

NATURE OF WORK (Tick all that apply):

Scaffolding (all kinds)Felling trees for logging
Buildings and structures over 5 metresTree felling for commercial firewood
Use of a lifting applianceTree felling in land clearance
Trench, shaft, pit, etcTree felling in maintenance of horticulture shelterbelts
Drive or headingTree felling in maintenance of overhead power lines
Excavated face over 5 metresTree felling in arboriculture
Use of explosivesTree felling in silviculture
Work in, or breathing, compressed air or air substituteTree felling for willow layering and other work in catchment areas
Restricted work involving asbestosTree felling involving wind throw
Demolition Other 

Description of Work *

LOCATION OF WORK:

Physical Address of
Worksite *

Main Access Road

Location
Provide directions on access as needed.  

CONTROL OF WORK:

*What is the status of your business in relation to this work? Principal (engaging a contractor or sub-contractor to do the work)
Employer (using own employees to do the work)

*Business Name:

*Business Address:

*Contact Name:  

*Phone:  

Fax:

*Email Address:

*Due date of commencement:

*Estimated Completion Date:

Date Created:

*The DoL Office nearest to the hazardous works: Select Region Whangarei Auckland-North Auckland-Central Auckland-South Hamilton Tauranga Rotorua Napier New-Plymouth Palmerston-North Lower-Hutt Wellington Nelson Christchurch Dunedin Invercargill