Application for a Licence to use a Scheduled Carcinogen

• Application for a Licence to use a Scheduled Carcinogen (PDF 124kb)
  Document Type: Form
  Keycode: FOR570/04/06.07
  Category: Hazardous Substances Licensing and Registrations 
  Publication Date: 09 July 2007
  Date First Published: 11 October 2006
  Summary: This form should be used to apply for a licence to use carcinogenic substances in a Laboratory or Industrial environment.

About this form

A licence is required for use of a Schedule 1 or Schedule 2 carcinogenic substance in a laboratory and for the use of a Schedule 2 carcinogenic substance in a workplace other than a laboratory. Use of a Schedule 1 carcinogenic substance in a workplace other than a laboratory is prohibited. You will need to complete this form and provide a detailed description of the control measures intended to be used to prevent exposure to the scheduled carcinogen. WorkSafe now requires proof of identification to be provided with this form. Therefore, unless you have previously done so, you will need to complete an Identification Form – Natural Person or Identification Form – Non Individual and submit it with your application.

A flat fee of $76.50 (GST exempt) is applicable for a licence to use a Schedule 2 carcinogenic substance in a laboratory. A licence processing fee of $67.50 per hour with a maximum of $761 (GST exempt) applies in all other cases.

Where to send the form

Submit your application form and all supporting documentation by mail: WorkSafe Victoria Occupational Hygiene Unit GPO Box 4293 Melbourne VIC 3001