Use this form to apply for an exemption from certain requirements of the Gas (Safety and Measurement) Regulations 2010.
WorkSafe may exempt any specific gas installation, gas appliance, fittings, person, or thing from any requirement imposed by or under all or any of regulations 16 to 28(external link) and Parts 4(external link), 6(external link), or 7.(external link)
An application for exemption must specify the precise exemption being sought and demonstrate how safety will be ensured if the exemption is granted. Supporting information should be attached to the application.
A fee of $408.89 (including GST) must accompany the application. Cheques are to be made out to WorkSafe New Zealand and should be marked "not negotiable".
Contact email@example.com for further assistance or requests for further
Once completed forward the form and fee to:
PO Box 165
This form is approved by the Manager, Energy Safety, acting under delegated authority from the Chief Executive, WorkSafe New Zealand.