Section 13: 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 in a laboratory and/or import for use in a laboratory of processed asbestos fibres or product(s) containing asbestos

Section 1: information related to the activities

Check the appropriate box:

[  ] This report relates to a laboratory that both:

Note: Check this box only when the information contained in the report is identical for both the use and the import; if the information is not identical, complete separate forms for the import and use.

[   ] This report relates only to the import for use in a laboratory of processed asbestos fibres, a product containing processed asbestos fibres or a consumer product containing asbestos in greater than trace amounts.

[   ] This report relates only to the use in a laboratory of processed asbestos fibres, a product containing processed asbestos fibres or a consumer product containing asbestos in greater than trace amounts.

Section 2: information respecting the importer/laboratory

Name:
Civic address in Canada:
Postal Address:

Section 3: information respecting the individual who is authorized to act for the importer/laboratory

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

Section 4: calendar year of the report

This report is submitted for the calendar year:

Section 5: information respecting the processed asbestos fibres or product(s)

If the report relates to the import/use of processed asbestos fibres:
Form and CAS RN:
Asbestos (if form is unknown) CAS RN 1332-21-4
Chrysolite 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:

Type of use (if reporting use, check the appropriate box(es)):

[  ] scientific research

[  ] analytical standard

If the report relates to the import/use of product(s):
Name of product:
Description:
Estimated concentration of asbestos:
Unit:
Estimated mass of asbestos:
Unit:
Number of product(s)

Type of use (if reporting use, check the appropriate box(es)):

[  ] scientific research

[  ] analytical standard

Rows can be added if required

Section 6: statement (complete only if the report relates to the use of processed asbestos fibres)

Check the box where appropriate:

[   ] 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 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 being collected under the authority of the provisions of subsection 93(1) of the Canadian Environmental Protection Act (1999) in accordance with Environment and Climate Change Canada’s (ECCC) Management of Toxic Substances (EC PPU 331) Personal Information Bank.

Any questions or comments regarding this privacy notice or the administration of the Privacy Act at ECCC may be directed to ECCC’s Access to Information and Privacy Division.

If you are not satisfied that we have adequately respected your privacy, you may wish to contact the Office of the Privacy Commissioner by calling their information Centre at 1-800-282-1376 or by visiting their contact page

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