Asbestos Forms

|
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 |

|
Form 2: * |
Application for Waiver Forms |

|
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. |

|
Form 5: * |
Asbestos Project Notification Forms |

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

|
Form 5A: * |
Supplemental Information required when the NESHAP notification is
substituted for Form 5. |

|
Form 6: * |
Application for Asbestos Occupation Course Approval Forms |

|
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.

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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Asbestos
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