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Below are notes on the completion of application form for WorkSafe’s exemption for requirements under regulation 109 of the Electricity (Safety) Regulations 2010.
The purpose of this form is to apply for a WorkSafe exemption pursuant to Regulation 109(external link) of the Electricity (Safety) Regulations 2010.
A fee of $408.89 must accompany the application. Cheques are to be made out to WorkSafe New Zealand and should be marked "not negotiable".
Additional information may be attached to the form if necessary.
Contact email@example.com for further assistance when applying for an exemption.
Please forward the form and fee, and direct any requests for further information to:
This form is approved by the Manager, Energy Safety, acting under delegated authority from the Chief Executive, WorkSafe New Zealand for the purposes of regulation 109 of the Electricity (Safety) Regulations 2010.