DHHS Internet Website - Public Health

Asbestos Program Forms

• Form 1*
  (Business Entities) Application for an initial or the renewal of licensed asbestos business entities; or for the waiver of entities not primarily engaged in asbestos projects.
  
  
• Form 2
  (Projects) Form to waive specific requirements established in Department regulations, or to request an alternative work practice.
  
  
• Form 3*
  (Individuals) Application for initial asbestos occupation licensure and limited occupation licensure.
  
  
• Reinstatement*
  (Individuals) Application for reinstatement to practice an asbestos occupation: for revoked, expired, inactive, lapsed, or the voluntary surrender of licenses without disciplinary action.
  
  
• Form 4*
  (Individuals) Asbestos occupation medical examination form, to be filled out by the MD performing the individual's physical exam.
  
  
• Form 5
  (Projects) Asbestos project notification form.
  
  
•  Nebraska Asbestos Waste Shipment Report Form*
  (Waste Generator) Form to be filled out by the contractor, facility, or operator who generates asbestos waste.
  
  
• NESHAP
  (Projects) Form for the notification of a demolition or renovation project; may be used in lieu of Form 5. Needs to be filed, regardless of the presence of asbestos.
  
  
•  Form 5A
  (Projects) Supplemental form to accompany the NESHAP, in lieu of submitting Form 5.
  
  
• Form 6*
  (Training Providers) Application for asbestos occupation training course approval.
  
  
• Form 7*
  (Business Entities) Form to request a waiver of a license in order to perform an emergency asbestos project.

*Forms may be completed online, however, they cannot be submitted via email due to the fact they require original signatures. If you complete the form online, it must be printed and mailed to the appropriate department for processing.

Forms 2, 5, 5A and the NESHAP may be scanned and emailed to Shelley Ball at: Shelley.Ball@nebraska.gov, faxed, mailed (via USPS Certified Mail- Return Receipt Requested, if desired) or hand-delivered.

DHHS- Division of Public Health, Environmental Health Unit

Office of Environmental Health & Indoor Air

P.O. Box 95026, 301 Centennial Mall South- 3rd Floor

Lincoln, Nebraska  68509-5026

Phone: 402-471-0386  Fax: 402-471-8833

Toll Free: 888-242-1100, Extension 1 (Nebraska only)

Email: DHHS.HealthHazardsIndoorAir@nebraska.gov

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Asbestos Program Page

Environmental Health Program