Section 12: 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: display of processed asbestos fibres in a museum

Section 1: information respecting the museum

Name:
Civic address in Canada:
Postal Address:

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

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 processed asbestos fibres

Form and CAS RN:
Asbestos (if form is unknown) CAS RN 1332-21-4
Chrysotile CAS RN 12001-29-5
Amosite CAS RN 12172-73-5
Crocidolite CAS RN 12001-28-4
Anthophyllite CAS RN 77536-67-5
Tremolite CAS RN 77536-68-6
Actinolite CAS RN 77536-66-4
Quantity:
Unit:
Period of display:

Section 5: statement

Check the box where appropriate:

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

Section 6: 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 7: 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.