Worksite address:
Date of submission (dd/mm/yyyy):
Building owner: Phone number: Email:
Prime contractor: Mailing address:
WSCC employer number: Contact person: Phone number: Email:
Lead abatement subcontractor(s): Mailing address:
WSCC employer number: Contact person: Phone number:
Email
:
Description of work activities:
Exact location of work area(s): Number of workers:
1 9 10 19 20+
Site supervisor: Phone number: Email:
Abatement risk level:
Low Moderate High
Start date (dd/mm/yyyy): End date (dd/mm/yyyy):
Building material(s) conrmed to contain Lead (include quantity and location of Lead):
1.
2.
3.
4.
5.
THE WSCC REQUIRES FIVE BUSINESS DAYS, FOLLOWING RECEIPT OF ALL SUPPORTING DOCUMENTATION, TO REVIEW LEAD
PROJECT SUBMISSIONS
SUBMIT THIS FORM INCLUDING ALL SUPPORTING DOCUMENTS TO projectnotications@wscc.nt.ca OR
projectnotications@wscc.nu.ca OR FAX 1 (866) 277-3677 CLEARLY INDICATING LEAD PROJECT NOTICE IN THE SUBJECT
Supporting documents:
Work procedures Worker training certicates
Emergency Procedures Waste Disposal Method
Analytical results or survey documents Air and surface monitoring and analysis
THE NORTHWEST TERRITORIES AND NUNAVUT WORKING WITH LEAD CODE OF PRACTICE DETAILS THE REQUIREMENTS FOR
LEAD ABATEMENT PROCEDURES AND IS AVAILABLE ON THE WSCC’S WEBSITE UNDER THE HEALTH & SAFETY SECTION
OFFICE USE ONLY
Date notice received (dd/mm/yyyy):
Received by: Email Fax
LPN number:
Receipt notice sent (dd/mm/yyyy): Date LPN accepted (dd/mm/yyyy): Processing Safety Ocer:
Lead Project
Notication Form
