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Notifications & forms

Included in this section is a range of forms for you to fill out and return to WorkSafe.

 

Notifiable events

WorkSafe must be notified when certain work-related events occur. Here we explain what types of event are notifiable and what you must do if a notifiable event occurs.

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Raise a work-related health or safety concern

If you have a concern about an unsafe or unhealthy work situation that could lead to a death or very serious injury or illness, then you can contact us with your concern.

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Making a complaint or concern about an authorisation holder

If you have a complaint or concern about a particular authorisation holder, you can raise it with WorkSafe.

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Particular hazardous work (Notifiable works)

Provide 24 hours notice of work that is particularly hazardous.

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Adventure activity operations

Notify WorkSafe New Zealand of your adventure activity operations.

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Amusement devices

Forms (applications, certificates and notices) related to amusement devices.

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Asbestos

Here you can download forms to register exposure to asbestos, apply for an asbestos removal licence, amend supervisor details on an existing licence, or to apply for a review of a reviewable decision.

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Electrical and gas

Use these forms to notify WorkSafe about an electricity or gas accident, and for reporting an unsafe electricity or gas installation.

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Notifiable Occupational Disease (NODS)

Notify WorkSafe NZ of a health problem that may have been caused by work.

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Occupational diving

Forms and notifications related to occupational diving.

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Petroleum

Application and notification forms for safety case assessments, well operations, and safety case concordance

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Certificates of Competence

Application forms for Certificates of Competence under the Health and Safety at Work (Mining Operations and Quarrying Operations) Regulations 2016

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Health monitoring report

Any business where workers are carrying out work for which health monitoring is required must complete a health monitoring report and send it to WorkSafe. This health monitoring report template has been developed for use by Work-related health (occupational) practitioners.

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HSNO Activities - Certification, Qualifications & Licensing

This section provides information and application forms for HSNO certification, qualifications and licensing of people, places and equipment.

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Registrations

Find information here on how to register activities with WorkSafe NZ or related training institutions.

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Interest in knowing enforcement action

Submit your interest in knowing whether a particular matter has been, is, or is to be subject to the taking of an enforcement action by a health and safety inspector.

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Provisional Improvement Notice (PIN)

Health and Safety Representatives (HSRs) may issue a Provisional Improvement Notice (PIN) if they believe that a person is breaking the law, or likely to break the law, a provision of HSWA, or the Regulations. A PIN may be issued to any person, including the business that the HSR works for, a worker or another business.

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Request removal of a Health and Safety Representative

A business may request that WorkSafe assist with removing an HSR, but for the regulator to remove an HSR there must be evidence that the HSR has not performed or exercised their functions or powers satisfactorily.

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Request assistance to resolve a work health and safety matter

Where attempts have been made and have failed to resolve a work health and safety issue, the PCBU, HSR, or worker can request WorkSafe to appoint an inspector to assist with the resolution of the issue.

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Request review of a Provisional Improvement Notice (PIN)

If a business is issued with a PIN and disagrees with it, it can within seven days, request WorkSafe to review the PIN by completing the Request a Review of a Provisional Improvement Notice (PIN) form.

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Request assistance to resolve issues relating to the cessation of work

Where attempts have been made and have failed to resolve a cessation of work issue, the business, HSR or worker can request WorkSafe's assistance.

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PLEASE NOTE

On Monday 4 April 2016, the New Health and Safety at Work Act 2015 (HSWA) came into effect.

HSWA repeals the Health and Safety in Employment Act 1992, with immediate effect.

All references to the 1992 Act on this website and within our guidance will be progressively removed.

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