Home > Health and Safety > Hazardous Work Notification

Particular Hazardous Work Notification Form

Use this form to notify WorkSafe New Zealand of Particular Hazardous Work as required under Regulation 26 of the Health and Safety in Employment Regulations (1995).

If you want to notify WorkSafe New Zealand of the death of a person, injury/illness sustained by someone or a workplace incident that exposed someone to serious risk, please click on the following link: http://forms.worksafe.govt.nz/notifiable-event-notification

Fields marked with an * are required

NATURE OF PARTICULAR HAZARDOUS WORK (Tick all that apply):










LOCATION OF WORK:




 

CONTROL OF WORK:





 




 

 

calendar popup button.

calendar popup button.

 

CERTIFICATE OF COMPETENCE:

calendar popup button.