National Asbestos Exposure Register

Please register your potential asbestos exposure with the Asbestos and Silica Safety and Eradication Agency’s database.

Are you registering a potential asbestos exposure on behalf of yourself or someone else? *

Your details

Include any international or local area code, no spaces

Please provide below the information about the person exposed to asbestos

Personal Details

Title *
Gender *
Please enter the date in dd/mm/yyyy format. For example 20/07/1969.
State/Territory *
Include any international or local area code, no spaces

Exposure to Asbestos

If you don’t remember the exact year, please put the year to the best of your recollection.
How were you exposed? *
Select which best suits your situation or where the greatest exposure/potential exposure occurred.

Residential

Residential status when exposed

Work

Was the exposure/potential exposure directly related to your work?
What was the nature of your job when exposed?
If exposed at work, has the relevant workplace regulator been informed?
If you were exposed in the past 12 months it is recommended you report the exposure to your workplace regulator. You can find the workplace regulator for your state or territory at https://asbestossafety.gov.au/organisation-links#regulators. The following are workplace regulators: Comcare; WorkSafe ACT, WorkCover NSW, SafeWork SA, WorkSafe TAS, NT WorkSafe; WorkSafe WA; WorkSafe QLD (WorkCover Qld); WorkSafe VIC (Victorian WorkCover Authority).

School/educational institution

Nature of your attendance when exposed

Environmental/domestic

Select the option which best suits your situation

In relation to the exposure questions you answered from the selections above, please describe how you were exposed.

Are you/have you been a smoker? *
Do you identify as Aboriginal or Torres Strait Islander? *
Have you been diagnosed with an asbestos related disease? *
How did you first find out about this register? *

Declaration and Privacy Statement

To submit this form please complete the following checkboxes *