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Asbestos Forms

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Form 1: *

Application for Initial License or Renewal of License for Business Entities Performing Asbestos Projects, and for Waiver of License for Business Entities Not Primarily Engaged in Asbestos Projects Forms

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Form 2: *

Application for Waiver Forms

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Form 3: &
Form 4:

Application for Asbestos Workers, Supervisors, Inspectors, Project Monitors, Project Designers, Limited Project Designer, Management Planner, Limited Management Planner Occupation Certification and Asbestos Occupational Medical Examination Forms.

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Form 5: *

Asbestos Project Notification Forms

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NESHAP*

NESHAP Form: Notification of demolition and renovation  (needs to be filed regardless of the presence of asbestos)

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Form 5A: *

Supplemental Information required when the NESHAP notification is substituted for Form 5. 

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Form 6: *

Application for Asbestos Occupation Course Approval Forms

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Form 7: *

Application for Emergency Waiver of License Forms

The forms indicated by an * may be completed on-line, however, they cannot be submitted via e-mail due to the fact that all applications and forms require original signatures. If you complete the form on-line, you must print the form and mail it to the address below.

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Nebraska Department of Health & Human Services
Division of Public Health, Environmental Health Unit
Office of Environmental Health & Indoor Air
Asbestos /Lead-Based Paint Program
301 Centennial Mall South, P.O. Box 95026
Lincoln, Nebraska 68509-5026
Phone: (402) 471-0386 Fax: (402) 471-8833
Toll Free 888-242-1100 ext 1 in Nebraska only
E-mail: bobbie.mills@dhhs.ne.gov


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