Asbestos Notification Form

Asbestos Notification Form
________________________________________________________________

Data Protection Note: This data may include personal information which is collected and processed by the Occupational Health and Safety Authority (OHSA collects and processes such information to fulfil its investigative, enforcement and regulatory role in accordance with the Health and Safety at Work Act – (Act XXXIII of 2024 Chapter 646) of the Laws of Malta and applicable subsidiary legislation. All data collected is processed in compliance with the General Data Protection Regulation (GDPR Data collected and processed by OHSA is held confidentially and not shared with any third parties except when necessary and with a justifiable legal basis. To learn more about how OHSA collects, keeps, and processes your private information in compliance with the GDPR, please view OHSA's Data Protection Policy which can be accessed through the following link: https://www.ohsa.mt/data-protection
Complete form has to be at OHSA, Chemical Section prior to the commencement of any work related to Asbestos or of material containing Asbestos subject to Regl. 3(2) of LN 323/2006
Details of Client
Date of Submission

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Name and Surname (that requested Asbestos work to be carried out)
ID Card Number
Full Address

0/40
Telephone
Format: 00000000.
Mobile
Format: 00000000.
Email
example@example.com
Company Name
MBR Company Registration Number
Address of Site (where Asbestos work will be carried out)
Details of Company/Person responsible for Asbestos work engaged by Client
Company Name or Name of responsible Person
Company MBR Reg. Number or ID Card No. of Responsible Person
Full Address
Telephone
Format: 00000000.
Mobile
Format: 00000000.
Email
example@example.com
Please indicate if any Asbestos work was subcontracted to third parties
If above reply is "YES", please insert details in Point a and b respectively otherwise insert "N/A"
a) Company Name or Name of responsible Person
b) Company MFSA Reg. Number or ID Card Number of responsible Person
Name and ID Card Number of Person supervising the Activity
Commencement Date of Work

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Please confirm that workers are fully informed and trained in a manner that is suitable and sufficient to satisfy the obligations of LN 323/2006
Expected duration of Works (in full days)
Maximum number of persons employed in the work at any one time
PA Asbestos Disposal Permit Number (attach copy of PA Authorization)
Attach copy of PA Authorization

Cancelof
Job Details
Exact Address / Location (or Department) from where Asbestos work will be carried out
Types and Quantities of Asbestos
Estimated quantities (cubic m)
Estimated quantities (cubic m)
Estimated quantities (cubic m)
Other (specify)
Type
0/10
Estimated quantities (cubic m)
0/10
Other (specify)
Type
0/10
Estimated quantities (cubic m)
Other (specify)
Type
0/10
Estimated quantities (cubic m)
Activities and Processes involved
Type of Work undertaken

Other
Other (Specify)
Activity of Work involved
These work methods should be avoided. If any of the below are ticked, justification must be included in a separate note. Specific reference to control measures must be included in the Plan of Work (next page)
Other (specify)
Please attach a copy of the Plan of Work (as per Section 11 of LN 323/2006)

Cancelof
Document Reference Number
Please attach a copy of the Assessment of Risk (as per Section 3 of LN 323/2006)

Cancelof
Document Reference Number
Applicant's Declaration
Name and Surname
ID Card Number
Hereby certify that the information shown within this Notification Form is correct to the best of my knowledge as given today

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Signature
Prior to the commencement of any work related to asbestos or of material containing asbestos subject to Regl. 3(2) of LN 323/2006, the completed form has to be at OHSA, Chemical Section
Should be Empty:

Details of Client

Details of Company/Person responsible for Asbestos work engaged by Client

Job Details

Types and Quantities of Asbestos

Activities and Processes involved

Activity of Work involved