Notification of an Abandoned Tank

NOTIFICATION OF AN ABANDONED TANK

This is an approved form for compliance with regulation 367 of the Work Health and Safety Regulations 2012.

Before completing this form refer to explanatory notes on page 2

A. Details of Person Conducting Business or Undertaking (PCBU)

Registered Name

Trading Name

Contact Name

ABN ACN

Business Entity (Please Tick One)

q Company q Partnership q Trust q Sole Trader q Other

Street Address Suburb State Post Code

Postal Address Suburb State Post Code

Email Address (if any) Website (if any)

Phone Fax

Mobile

B. Details of Premises where tank is/was located

Please attach a certificate or statutory declaration from a competent person that states the abandonment was undertaken in accordance with the relevant Australian Standard:

·  AS4976:2008 The removal and disposal of underground petroleum storage tanks

·  AS/NZS 1596:2014 The storage and handling of LP gas

Street Address Suburb State Post Code

Tank details (tank type, capacity, hazardous chemical previously stored)

Abandonment details (date abandoned, method)

C. Declaration by Notifier

Full Name Holding the position of (job title)

In (Registered name of organisation)

At (Business address or location)

I hereby declare that:

The information in this notification is true and correct to the best of my knowledge.

For body corporate notifiers, I have authority from the body corporate to complete and submit this notification.

I consent to WorkSafe Tasmania making enquiries and exchanging with WHS regulators in other states or territories or the commonwealth regarding any matter relevant to this notification.

Signature:

D. How to Lodge This Form

·  complete all relevant sections

·  ensure statutory declaration relevant to abandonment is attached

·  submit to WorkSafe Tasmania by fax, post, or email to

·  no fee applies

E. Explanatory Notes

The person conducting a business or undertaking (PCBU) at the workplace must notify WorkSafe Tasmania on abandonment of an underground, partially underground or fully mounded tank which was used to store flammable gases or flammable liquids.

The tank is taken to be abandoned if:

·  the tank has not been used to store flammable gases or flammable liquids for 2 years, or

·  the tank is not intended to store flammable gases or flammable liquids again

The term “tank” means a container, other than an IBC designed to use, handle or store hazardous chemicals in bulk, and includes fittings, closures and other equipment attached to the container.

Notification must be made as soon as practicable after the tank is abandoned.

Privacy Compliance Statement

The personal information you provide in this notification will be used by WorkSafe Tasmania for that purpose and may be used for other purposes permitted by the Work Health and Safety Act 2012 and associated laws.

Your personal information may be disclosed to contractors or agents or WorkSafe Tasmania, law enforcement agencies, courts and other public sector bodies or organisations authorised to collect it.

This information will be managed in accordance with the Personal Information Protection Act 2004 and may be accessed by you on request to this Department. You may be charged a fee for this service.

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