e-form Asbestos Notification Form Complete form has to be at OHSA, Chemical Section (email: chemicalagents.ohsa@gov.mt) prior to the commencement of any work related to Asbestos or of material containing Asbestos subject to Regl. 3(2) of LN 323/2006 For OHSA use ONLY
File Number Details of Client Name and Surname
(that requested Asbestos work to be carried out) ID Card Number Full Address Telephone Mobile Fax Number Email 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 Number of responsible Person Full Address
Telephone Mobile Fax Number Email Please indicate if any Asbestos work was subcontracted to third parties NO YES 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 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 NO YES 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 Authorisation) 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) Amosite (brown or grey) Estimated quantities (cubic m) Crocidolite (blue) Estimated quantities (cubic m) Other (specify) Type Estimated quantities (cubic m) Other (specify) Type Estimated quantities (cubic m) Other (specify) Type Estimated quantities (cubic m) Activities and Processes involved Type of Work undertaken Asbestos Insulation Asbestos Insulation Board Asbestos Coating Textured 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 Stripping Use of Power Tools Work 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) Document Reference Number Please attach a copy of the Assessment of Risk (as per Section 3 of LN 323/2006) Document Reference Number Applicant's Declaration I,
ID Card Number hereby certify that the information shown within this Notification Form is correct to the best of my knowledge as given today Date 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
(email: chemical@ohsa.mt) The Data Protection Act XXVI, 2001 requires that the Occupational Health and Safety Authority (OHSA) informs you that this form may include information about you (this is called 'personal data' in the Act) and that we are a 'data controller' for the purposes of this Act.
OHSA will process the data for health and safety purposes. OHSA may disclose the data to any person or organisation for the purposes for which it was collected or where the Act allows disclosure.
As data subject, you have the right to ask for a copy of the data and to ask for any inaccurate data to be corrected.