Location Compliance Certificate
Application Form

LCC Application Form
  • Contact Details
  • On-site Particulars
  • Application Checklist
    • Declaration
    Please do not refresh or navigate away from this page until you have submitted this form as you must do it in one sitting.

    You will need the following documents ready before submitting this application

    • A copy of the company registration details and bank deposit slip
    • Evidence of prior Compliance Certification (if applicable)
    • All email correspondence and notices from WorkSafe / Enforcement Officer
    • Hazardous Substances Inventory List that is up-to-date for all hazardous substances you have on site
    • Established training records for all your staff who handle, or are around Hazardous Substances
    • Records for Certified Handlers and/or Approved Handlers at your site (if applicable)
    • A HSWA compliant Site Plan for your site
    • Evidence of security measures for each hazardous substance location for your site
    • Copies of your Emergency Management Response Plan or ERP Practice documents
    • Copies of disposal documentation for your site
    • Documentation on the control of unintended ignition for your site
    • Records of PPE selection, training, and maintenance to include:
      • Medical Assessment (ensuring staff can use respirators, 
      • Selection of PPE (degradation/accumulation), 
      • Maintenance + Repair: filter replacement, leaks, holes, 
      • Compatibility with other PPETraining: fitting, checking/testing, replacing parts, what to use and when, 
      • Fitting correct for worker, daily inspection, and separate storage requirements

     

    PCBU / Officer Details

    Full Name
    Full Name
    First
    Middle
    Last

    Business Information

    Are you trading under a different name?
    Business Address *
    Business Address
    Address Line 1
    Address Line 2
    City
    State/Province
    Zip/Postal
    Is your postal address the same as above?
    Postal Address *
    Postal Address
    Address Line 1
    Address Line 2
    City
    State/Province
    Zip/Postal
    Is this address the same address where LCC is required?
    Please specify the address where LCC is required *
    Please specify the address where LCC is required
    Address Line 1
    Address Line 2
    City
    State/Province
    Zip/Postal

    Accounts Information

    Name of Company Accounts Point of Contact
    Name of Company Accounts Point of Contact
    First
    Last

    Maximum file size: 16.78MB

       

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    Location Compliance Certificate Application Form

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