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									HVIC Response Form

                                              Company Details
Company name
Company address
Contact name                                                        Position
Phone number                                                 Fax number
Please amend Company Details as necessary
Do You Need to report?

Q1- Does your company introduce (import and/or manufacture) any industrial chemicals?
(Note: Mixtures generated by blending chemicals, without a chemical reaction taking place, are not considered manufactured ).
  NO            You do not need to report. Please complete company details, sign and return
                      this form to NICNAS.
  YES                  Please go to question 2.

Q2- Are any introduced industrial chemicals, reportable* chemicals?
(*Please read guidance document to determine the need to report as some types of chemicals are exempt ).
  NO            Please complete company details, sign and return this form to NICNAS. No
                      further action needed.
  YES                  Please go to question 3.

Q3-     Are any reportable chemicals, introduced at > 20 tonnes per annum as a discrete chemical
        or in a product/mixture at > 100 tonnes per annum?
  NO                   Please complete company details, sign and return this form to NICNAS. No
                        further action needed.
  YES                  Please complete and return this form together with a completed HVIC
                        Chemical Reporting Form (copy attached) for each reportable industrial
                        chemical introduced at > 20 tonnes.

I declare that to the best of my knowledge all the information in this submission is true, correct and complete. In relation
to the information, I declare that I am entitled to use and give the Director all data supplied herein.

Name                                                    Position

Signature                                                       Date

Note: It is an offence under the Industrial Chemicals (Notification and Assessment)Act (the Act) to supply a statement,
which is false or misleading.

             Is your company a small business with less than 20 employees? (please circle): YES         NO
  If your company is a small business with less than 20 employees, please estimate the time spent completing this form:
                                                   Hrs           Mins
                              HVIC Chemical Reporting form
Chemical details
Chemical Abstract Services (CAS) Number
Other Number (please specify)
Chemical name (as in AICS)

Other name (please specify)

Marketing name
Quantity manufactured (metric tonnes)
Quantity imported (metric tonnes)
Reporting period (please tick one)                2004/05 Financial year                  2005 Calendar year 
Note: It is an offence under the Industrial Chemicals (Notification and Assessment) Act (the Act) to supply a statement which
is false or misleading.

If you would prefer to compile the information on an excel spreadsheet, you may
attach the HVIC Response form to a spreadsheet containing the following fields:

        CAS Number
        Other Number (if CAS Number is not available)
        Chemical name in AICS
        Other name (please specify)
        Marketing name
        Quantity manufactured (metric tonnes)
        Quantity imported (metric tonnes)
        Reporting period (2004/05 Financial year or 2005 Calendar year)
        (A) Industrial Category (Choose from the 18 on page 3)
        (B) Use Category (Choose from the 55 on pages 4 to 6)

       Return completed form to:
                                        HVIC Reporting
                                        GPO Box 58
                                        SYDNEY NSW 2001
                                        FAX: +61 2 8577 8888
                                        Email: HVIC@nicnas.gov.au
Use pattern
Please tick the box of one or more of the categories below that best describe:
(A) the industrial category (s) and (B) use category (s) for the chemical.

            (A) Industrial Category: industry in which the chemical is used

Cosmetics/Personal                                 Plastics
e.g. Hair, nail, kip, skin, cleaners – hand/body,   e.g. Monomers, catalysts, base resins, additives
eye, oral cavity, perfume, deodorant, personal      – flame retardants, additives – microbial,
products                                            additives - other

Domestic/Cleaning                                  Printing Industry
e.g. Air freshener/deodoriser, cleaners –           e.g. Acrylates/Plate making, inks, other
surface, dishwashing, laundry                       lithographic applications

Education, Research &                              Refrigeration
                                                    Surface Coatings
Electrical/electronic engineering                  e.g. Auto – refinishing, auto – original
industry                                            equipment manufacture, architectural – solvent
                                                    based, architectural – water based, industrial
Engineering                                        coatings
e.g. Adhesives/sealants, concrete, other
                                                    Textile Processing
Explosives                                         e.g. Dyes, softeners, others

 and Oil
                                                     Treatment
e.g. Fuel and fuel additives, oil – general
automotive, oil – other, hydraulic fluid

Leather Processing
e.g. Colouring, preservative

Manufacture of Other Chemicals

Mining and Metal Extraction
e.g. Flotation agent, other

 Supplies
e.g. Photocopying/laser printing, inkjet
printing, other office supplies

 & Pulp
e.g. Surfacing chemicals, other additives

e.g. Film and paper manufacture, developing
  (B) Use Category: The functional use of the chemical (not industry-specific)

Absorbents and adsorbents                              Substances used to remove dirt or impurities
Materials used to absorb or adsorb gases or             from surfaces.
liquids: filter material/media; molecular sieves;
silica gel etc..                                        Sub-categories: detergents; soaps; dry cleaning

                                                        solvents; optical brighteners in detergents.
 Adhesives: binding agents
Materials which are applied to two surfaces             Colouring agents
causing them to adhere: dispersion-based                Substances used to impart their colour to other
adhesives, hotmelt, resins for polymer-based            materials.
hardening adhesives, solvent-based adhesives.           Sub-categories : dyestuffs; pigments (including

                                                        toners); colour forming agents; fluorescent
 Aerosol propellants                                    brighteners (but see below re detergents).
Compressed or liquefied gases within which              Not : cosmetics; food colours;
substances are dissolved or suspended and               photo-chemicals; optical brighteners used
expelled from a container upon discharge of             exclusively in detergents; reprographic agents.
the internal pressure through expansion of the
gas.                                                    Complexing agents

                                                        Substances used to combine with other
 Anti-condensation agents                               substances (mainly metal ions) to form
 Substances used to avoid condensation on               complexes.
 surfaces and in the atmosphere: anti-dim
agents, condensation removers.                          Conductive agents

                                                        Materials used to conduct electrical current.
 Anti-freezing agents                                   Sub-categories: electrolytes; electrode
Substances used to prevent and remove ice               materials.
formation: antifreeze liquids, de-icing agents.
                                                        Construction materials additives
Anti-set-off and anti-adhesive                         Substances used in building materials and
agents                                                  constructional articles: wall
                                                        constructionmaterials; road surface materials,
Substances used to prevent set-off and
                                                        ceramic, metal, plastic and wooden
adhesion: spraying powder and anti-set-off
                                                        construction materials.
additives for printing; oils and waxes for laths
and shuttering; casting slip etc..
                                                        Corrosion inhibitors
Anti-static agents                                     Substances used to prevent corrosion:
                                                        corrosion-inhibiting additives; rust preventives.
Substances used to prevent or reduce the
tendency to accumulate electrostatic charges:
anti-static additives; substances for surface
treatment against static electricity.                   Substances used as components of cosmetic
                                                        and toiletry formulations.
Bleaching agents
                                                         binding agents
Substances used to whiten or decolourise
                                                        Substances used to control finely divided solid
                                                        particles of powdered or ground materials to reduce
Not:cosmetics; photographic bleaches; optical           their discharge into the air.

Cleaning/washing agents and
                                                        Electroplating agents
                                                        Substances used as a source for a layer of
additives                                               metal deposited on another surface; or that aid
                                                        such a deposition.

                                                         Sub-categories: anti-fouling agents; antiknock
 Explosives                                              agents; deposit modifiers; fuel oxidisers.
Substances or mixtures that are characterised
by chemical stability but that may be made to             transferring agents
undergo chemical change, rapidly producing a             Substances used to transmit or to remove heat
large quantity of energy and gas accompanied             from a material.
by bursting or expansion.                                Sub-categories: cooling agents; heating agents.

Sub-categories: blasting agents; detonators;
incendiaries.                                             Hydraulic fluids and additives
                                                         Fluids used for transmitting pressure.

Relatively inert, and normally non-fibrous,              Impregnation agents
finely divided substances added to elastomers,           Substances used to admix with solid materials,
plastics, paints, ceramics etc., usually to extend       which retain their original form: impregnating
volume which may improve desired properties              agents for leather, paper, textile and wood.
such as whiteness, lubricity, density or tensile         Not: flame retardants; conserving agents;
strength.                                                biocides.

 agents
 Fixing                                                  Insulating agents
Substances used to interact with a dye on fibres         Agents used to prevent or inhibit the flow of
to improve fastness.                                     electrical current, heat or light or the

 retardants and fire-
                                                         transmission of sound.

preventing agents                                        Laboratory chemicals
Substances incorporated into, or applied to the          Substances used in laboratories for analytical
surface of, materials to slow down or prevent            purposes.

                                                          Lubricants and additives
Flotation agents                                        Substances entrained between two surfaces and
Substances used to concentrate and obtain                thereby used to reduce friction: oils; fats;
minerals from ores: flotation oil; flotation             waxes; friction-reducing additives.

                                                          agents
 agents for casting
 Flux                                                    Substances used to produce, enhance or mask
Substances used to promote the fusing of                 odour.
minerals or prevent oxide formation.                     Not: food additives; cosmetics.

Foaming agents                                          Oxidising agents
Substances used to form a foam or cellular               Substances that give up oxygen easily, remove
structure in a plastic or rubber material                hydrogen from other substances, or accept
physically by expansion of compressed gases              electrons in chemical reactions, and are used
or vaporisation of liquid, or chemically by              for such purposes.

decomposition evolving a gas.
Sub-categories: chemical or physical blowing              pH-regulating agents
agents; frothers.                                        Substances used to alter or stabilise the

                                                         hydrogen ion concentration (pH): acids;
 Fuels                                                   alkalis; buffers.

Substances used to evolve energy in a
controlled combustion reaction.                           Photochemicals
Sub-categories: gasoline; kerosene; gas oil;             Substances used to create a permanent
fuel oil; petroleum gas; non-mineral oil.                photographic image.

 additives
                                                         Sub-categories: desensitisers; developers;
 Fuel                                                    fixing agents; photosensitive agents;
Substances added to fuels.

sensitisers; anti-fogging agents; light
stabilisers; intensifiers.                               Stabilisers
Process regulators
                                                        Substances used to prevent or slow down
                                                        spontaneous changes in, and ageing of,
Substances used to regulate the speed of a              materials.
(chemical) process.                                     Sub-categories: antioxidants; heat stabilisers;
Sub-categories: accelerators; activators;               light stabilisers; scavengers; charge stabilisers.

catalysts; inhibitors; siccatives;
anti-siccatives;cross-linking agents; initiators;        Surface-active agents
photo-initiators etc..                                  Substances used to lower the surface and/or

Reducing agents
                                                        interfacial tension of liquids and promote
                                                        cleaning, wetting, dispersion etc..

Substances used to remove oxygen,
hydrogenate or, in general, act as electron              Tanning agents
donors in chemical reactions.                           Substances used for treating hides and skins.

Reprographic agents                                    Viscosity adjusters
Substances used to reproduce a permanent                Substances used to modify the flow
image.                                                  characteristics of other substances, or mixtures,
Sub-categories: toner for photocopying                  to which they are added.
machines; toner additives.                              Sub-categories: pour point depressants;

                                                        thickeners; thixotropic agents; turbulence
                                                        suppressors; viscosity index improvers.

Substances having resistivities that are
between those of insulators and metals, and are          Vulcanising agents
usually changeable by light, heat or electrical         Substances added to rubber to aid and hasten
or magnetic field, or generate electromotive            vulcanisation: vulcanisation- accelerators and
force upon the incidence of radiant energy.             vulcanising assistants.

Sub-categories: semiconductors; photovoltaic
agents.                                                  Welding and soldering agents
                                                        Materials used for welding and soldering;
                                                        electrodes; flux; powdered metal; wire etc..

                                                        Others (Please specify)
Substances used for softening materials to
improve feel, to facilitate finishing processes
or to impart flexibility or workability.                Substances whose technical functions are not
Sub-categories: coalescing agents; bates                described elsewhere.
(leather technology); devulcanising agents;             _______________________________
emollients; swelling agents; water softeners;
plasticisers.                                           _______________________________
Solvents                                               _______________________________
Substances used to dissolve, thin, dilute and           _______________________________
extract: extraction agents; solvents and                _______________________________
thinners for paints, lacquers, adhesives and
other materials.


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