Use this form to apply for an exemption from certain requirements of the Gas (Safety and Measurement) Regulations 2010.

WorkSafe may exempt any specific gas installation, gas appliance, fittings, person, or thing from any requirement imposed by or under all or any of regulations 16 to 28(external link) and Parts 4(external link)6(external link), or 7.(external link)

Gas (Safety and Measurement) Regulations 2010(external link)

An application for exemption must specify the precise exemption being sought and demonstrate how safety will be ensured if the exemption is granted. Supporting information should be attached to the application.

A fee of $408.89 (including GST) must accompany the application. Cheques are to be made out to WorkSafe New Zealand and should be marked "not negotiable".

Contact for further assistance or requests for further

 Once completed forward the form and fee to:

Energy Safety
PO Box 165
Wellington 6140
New Zealand

This form is approved by the Manager, Energy Safety, acting under delegated authority from the Chief Executive, WorkSafe New Zealand.

Application for Exemption (PDF 220 KB)