Section 11: Prohibition of Asbestos and Products Containing Asbestos Regulations

Please use the PDF version to complete your report. The HTML versions are provided for on-line reading purposes only.

You may complete your report electronically, or you may print it and complete the fields by hand.  All reports require a signature.

Reports should be submitted by mail or email to:

Chemicals Management Division
Environment and Climate Change Canada
351 St-Joseph Blvd, 10th floor
Gatineau QC  K1A 0H3
Email: ec.amiante-asbestos.ec@canada.ca

Report: use of product(s) containing processed asbestos fibres to service equipment of a nuclear facility

Please download, fill, print and send back the PDF version of the above form.

Section 1: information respecting the nuclear facility

Name:
Civic address in Canada:
Postal address:

Section 2: information respecting the individual who is authorized to act for the nuclear facility

Name:
Title:
Telephone number:
Civic address in Canada:
Email address:
Postal Address:

Section 3: calendar year to which the report relates

This report is submitted for the calendar year:

Section 4: information respecting the equipment

Name of the equipment serviced with a product containing processed asbestos fibres:
Description of the equipment:
Rows can be added if required

Section 5: information respecting the product(s) used to service the equipment

Name of the equipment:
Product(s) containing processed asbestos fibres:
Name:
Description:
Estimated concentration of asbestos:
Unit:
Estimated mass of asbestos:
Unit:
Number of product(s) used to service the equipment:
Rows can be added if required

Section 6: statements

Check the box where appropriate:

[ ] The equipment listed in section 4 of this Report was serviced using products containing processed asbestos fibres listed in section 5 of this Report because no technically or economically feasible asbestos-free alternative was available at the time the equipment was serviced.

[ ] An asbestos management plan that meets the requirement of Schedule 1 of the regulations has been implemented.

Section 7: request for confidentiality

Indicate if you are requesting confidentiality under Section 313 of the Canadian Environmental Protection Act, 1999 (CEPA).

[ ] Pursuant to section 313 of the CEPA, I request that the following parts of the information I am submitting will be treated as confidential. Please specify the parts [e.g. sections, tables] and include the reason for your request.

[ ] I do not request confidentiality for the information I am submitting and I consent to its release without restriction.

Section 8: certification

I certify that this information is accurate and complete.
Date:
Place:
Signature of the individual authorized to submit this Report

Disclaimer

This form is provided for information purposes only and may not include all legal requirements. If there is any inconsistency or conflict between the information contained in this document and the Canadian Environmental Protection Act, 1999 (CEPA) and/or the Prohibition of Asbestos and Products Containing Asbestos Regulations, the official versions of the Act and regulations take precedence. The official versions of the regulations can be found at Prohibition of Asbestos and Products Containing Asbestos Regulations (SOR/2018-196).

Privacy notice statement

Personal information on this form is collected under the authority of the CEPA and is protected from disclosure to unauthorized persons/agencies pursuant to the provisions of the Privacy Act.

Questions or comments regarding this privacy notice or the administration of the Privacy Act at Environment and Climate Change Canada may be directed to the Access to Information and Privacy Coordinator at ec.aiprp-atip.ec@canada.ca.

If you are not satisfied that your privacy has been respected, you may contact the Office of the Privacy Commissioner of Canada at info@priv.gc.ca or by calling 1-800-282-1376.

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