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Application For A Licence To Use A Scheduled Carcinogen

  • Application for a Licence to use a Scheduled Carcinogen (PDF 225kB)
    Document Type: Form
    Keycode: FOR570/06/03.16
    Category: Hazardous Substances, Licensing and Registrations, 
    Publication Date: 18 March 2016
    Date First Published: 11 October 2006
    Summary: This form should be used to apply for a licence to use carcinogenic substances in a Laboratory or Industrial environment.

About this form

About the licence
Apply or renew
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About the Licence 

Carcinogenic substances are hazardous substances that can cause cancer. You must have a licence if you intend to use schedule 1 or 2 carcinogenic substances.

Schedule 1 carcinogenic substances

  • 2-Acetylaminofluorene
  • Aflatoxins
  • 4-Aminodiphenyl
  • Benzidine and its salts
  • Bis(chloromethyl) ether
  • Chloromethyl methyl ether (technical grade)
  • 4-Dimethylaminoazobenzene
  • 2-Naphthylamine and its salts
  • 4-Nitrodiphenyl

Schedule 2 carcinogenic substances

  • Acrylonitrile
  • Benzene – when used as a feedstock containing more than 50% benzene by volume
  • 3,3'-Dichlorobenzidine and its salts
  • Diethyl sulfate
  • Dimethyl sulfate
  • Ethylene dibromide – when used as a fumigant
  • 4,4'-Methylene bis(2-chloroaniline)
  • 2-Propiolactone
  • o-Toluidine and o-Toluidine hydrochloride
  • Vinyl chloride monomer


  • Class 1 (Schedule 1 carcinogen in a laboratory only)
  • Class 2 (Schedule 2 carcinogen in a workplace other than laboratory)
  • $67.50 per hour processing fee (up to a maximum of $761). You will be notified of this fee after your application has been processed and an inspection has been conducted in the intended workplace where the scheduled carcinogen will be used.
  • Class 3 (Schedule 2 carcinogen in a laboratory only)
  • $76.50 flat fee

Licence is valid for up to 5 years.

Where to send the form

WorkSafe Occupational Hygiene unit
GPO Box 4306
VIC 3001

Apply or renew the licence 

Complete a separate application form for each scheduled carcinogen and provide:

  • details of the carcinogen you intend to use and a detailed description of the control measures used to prevent exposure to the scheduled carcinogen
  • Identification form – natural person to be completed by the individual who is applying for, or nominating someone to, access the HCDG. You must also provide:
    • 100 points of identification at least one with a photograph and signature,
    • identification showing your date of birth,
    • 2 verified passport sized photographs
  • Identification form – non-individual only complete this form if applicant is a body corporate or company. (If you have previously completed these identification forms, you do not need to complete them again, unless your details have changed.)

If you are renewing your licence you are not required to complete the identification forms again unless your details have changed. In addition to providing the information above, please provide your existing licence number.

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