Asbestos Notification Form

Asbestos Notification Form
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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
Name and Surname (that requested Asbestos work to be carried out)*
ID Card Number
Full Address*

0/40
Telephone*
Mobile*
Email*
example@example.com
Company Name*
MFSA Company Registration Number*
Address of Site (where Asbestos work will be carried out)
Details of Company/Person responsible for Asbestos work engaged by Client (details in page 1)
Company Name or Name of responsible Person
Company MFSA Reg. Number or ID Card No. of Responsible Person
Full Address
Telephone*
Mobile*
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
Date
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

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Job Details
Exact Address / Location (or Department) from where Asbestos work will be carried out*
Types and Quantities of Asbestos
Chrysotile (white)
Estimated quantities (cubic m)
Crocidolite (blue)
Estimated quantities (cubic m)
Amosite (brown or grey)
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

Asbestos InsulationAsbestos Insulation BoardAsbestos CoatingTextured Coating
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)

Dry StrippingUse of Power ToolsWork on or in Proximity to Hot Surfaces
Other (specify)
Please attach a copy of the Plan of Work (as per Section 11 of LN 323/2006)

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

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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
Date
Signature

Clear
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 (details in page 1)

Job Details

Types and Quantities of Asbestos

Activities and Processes involved

Activity of Work involved