Forms
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Most forms on
this page can be printed off, completed and then faxed or delivered
to the relevant local Territory
Business Centre (TBC) or an NT
WorkSafe office. Some forms are placed on the web site as samples
only. This is indicated on the relevant forms.
Forms that require
a signature for licensing purposes must be hand delivered to your
closest TBC where you will be provided with a label for signing.
This label must then be attached to the form you have printed from
this web site.
Some of the following form categories have special instructions.
Please click on the blue form category heading to access the required form.
| Applications |
| FM122 |
Application for authorisation of an explosive |
| FM124 |
Application to become a fireworks assessor |
| FM150 |
Application for internal review of a decision made by the Authority |
| FM154 |
Application for Registered Training Organisation to distribute NT white card - construction induction training |
| Authority |
| PF095 |
Criminal History Check - Application |
| Form |
Authority to Release Traffic Infringement and Traffic Conviction History |
|
FM153 |
Security clearance SSAN |
| FM128 |
Statutory declaration |
| Declarations/Experience |
| FM016 |
Declaration of experience - Crane
and hoist operation experience |
| FM014 |
Declaration of experience - Dogging
experience |
| FM029 |
Declaration of experience - general pressure equipment operation, boiler mechanic, lift mechanic, asbestos removalist |
| FM015 |
Declaration of experience - Mobile
crane and forklift |
| FM013 |
Declaration of experience - Scaffolding |
| FM131 |
Shotfirers
renewal of licence and reciprocal |
| Licenses |
| FM133 |
Asbestos
licences - prerequisite for renewal |
| FM116 |
Convey
dangerous goods - yearly licence |
| FM011 |
Dangerous goods licence |
|
|
| FM118 |
Application for a licence (retail)
to possess, store and sell shopgoods fireworks - Territory Day
celebrations only |
| FM081 |
Application for a licence (wholesale)
to possess, store and sell shopgoods fireworks - Territory Day
celebrations only |
| FM010 |
OHS
and asbestos
|
| FM012 |
Replacement
licences (all)
|
| FM080 |
Store/sell/possess
dangerous goods |
| Medical |
| FM028 |
Dangerous goods medical certificate |
| Notifications |
| FM030 |
Gas - notice of intention to commence work |
| FM045 |
Designated plant - sale or disposal |
| FM105 |
HSR Notification of Safety Hazard (NOSH) |
| FM134 |
Explosives - notice of arrival |
| FM137 |
Accident/incident notification form |
| FM086 |
Explosives - notice of intention to import or export |
| FM087 |
Notice of intention to import/export shopgoods fireworks |
| FM019 |
Notification of work - other than removal of asbestos |
| FM019a |
Notification of work - removal of asbestos or material containing asbestos
|
| Permits |
|
FM083 |
Application
for a permit - for fireworks display or special effects |
| Records/Reports |
|
FM043 |
Designated
plant inspector report |
| FM036 |
Designated plant
inspector return |
| Registrations |
FM020 |
Application to register designated
plant |
| FM035 |
Application to register as a Designated Plant Inspector |
| FM035a |
Application for Designated Plant Inspector renewal |
| FM038 |
Application to register lift, escalator and moving walk design |
| FM037 |
Application to register pressure
equipment design |
| FM039 |
Application to register vehicle
hoist design |
| FM044a |
Application to register tower crane design |
| FM044b |
Application to register bridge crane design |
| FM044c |
Application to register gantry crane design |
| FM044d |
Application to register mobile crane design |
| FM046 |
Application to register register elevated work platform design |
| FM051 |
Application to register register amusement structure design |
| FM052 |
Application to register register prefabricated scaffolding design |
| FM053 |
Application to register register workboxes suspended from crane design |
| FM054 |
Application to register register concrete placing boom design |
| FM114 |
Application to register tower crane concrete base design |
| FM152 |
Application to register personnel and material hoist design |
| Rehabilitation and compensation |
| FM1900 |
Workers compensation claim form and instructions
|
FM19111 |
First medical certificate - compensation
|
FM19101 |
Progress medical certificate - compensation
|
FM19088 |
Final medical certificate - compensation
|
FM009 |
Rehabilitation treatment checklist
|
|
