Application To Conduct A National Police Check And ASIO Security Assessment

About this form

Use this Application to Conduct National Police Check and ASIO Security Assessment if you are applying for a licence that requires you to be a suitable person. If you complete this form, you are consenting to WorkSafe Victoria (WorkSafe) obtaining sufficient information to assess your suitability to obtain a licence.

Under the Dangerous Goods Act and the Regulations, WorkSafe may refuse to issue or renew a licence where, amongst other things:

(a) WorkSafe believes that the risk of injury or damage to persons or property which may be incurred by an accident involving dangerous goods is too great in the circumstances to justify the issue or renewal
(b) WorkSafe considers the applicant is not a suitable person to hold the licence
(c) an adverse ASIO security assessment has been received about the applicant, or
(d) a search of known information about the applicant has been made and the applicant has been convicted, found guilty of or has a charge pending for any offence relating to violence, weapons, terrorism, damage to property, illegal drugs or dishonesty within the last 10 years that in WorkSafe's opinion would pose a security risk in relation to that person.

It is therefore a requirement of the Dangerous Goods Act 1985 and Regulations that an applicant consents to WorkSafe obtaining known information to enable WorkSafe to determine whether the person is suitable to have a Dangerous Goods Licence or Permit.

It is also a requirement under the Regulations that an applicant consent to an ASIO security assessment. An ASIO security assessment is for life therefore you only have to provide consent to WorkSafe once, but you will need to consent to a national police check every time you apply, amend or renew your licence.

If you believe you have completed an ASIO security assessment for another WorkSafe Licence/Permit application, then you do not have to complete it with this application. If WorkSafe's records show that you have not consented to this check in the past then you will be contacted by WorkSafe and required to complete this form and pay the applicable fee before your Licence/Permit can be issued.

Payment Details

The fee for National Police Check is an additional $40.00, payable with very application and an additional $20.00 if an ASIO Security assessment is required.

Where to send the form

This form should only be lodged with another application form. The specific licence application will provide you with instructions on how to lodge this form. The Application to Conduct a National Police Check and ASIO Security Assessment form should not be sent to WorkSafe Victoria without an accompanied application form

Further information


Direct any enquiries regarding completing and submitting this form to the Licensing Branch on 1300 852 562.

Enquiries relating to explosives, High Consequence Dangerous Goods (HCDG) and the regulations should be directed to the Advisory Service on 1800 136 089.