Registration Form - Cooling Towers & Evaporative Condensers
Health and Safety etc. Act 1974
The Notification of cooling Towers and Evaporative Condensers Regulations 1992
Notification of Notifiable Device (s)
1. Address where cooling tower(s)/evaporative condenser(s) is/are to be situated:
Name of Premises: .………………………………………………………………………………………….….
Address: ………………………………………………………………………………………………………….
……………………………………………………………………………………………………………………..
2. Person(s) in control of premises:
Name of person: …………………………………………………………………………………………………
Company Name: …………………………………………………………………………………………………
Address: …………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………...
Telephone number: ……………………………………………………………………………………………...
NB: This information is required to enable access to be gained at all times to the notifiable device(s)
3. How many cooling towers or evaporative condensers are at the address shown above? ………….
4. Please give brief location of each piece of equipment being registered at this time eg. main
building, corner of roof: ………………………………………………………………………………………….
……………………………………………………………………………………………………………………...
……………………………………………………………………………………………………………………...
……………………………………………………………………………………………………………………...
Declaration
I am aware of the provisions of The Notification of Cooling Towers and Evaporative Condensers Regulations
1992. The details contained in the application form and any attached documentation are correct to the best
of my knowledge and belief.
Signed by: ……………………………………………… Date:…………………………………………………
Name: …………………………………………………... Position: …………………………………………
Please send completed form to:
Worcestershire Regulatory Services, Wyre Forest House, Finepoint Way, Kidderminster,
Worcestershire DY11 7WF
NOTE: Where any change occurs which affects the particulars contained within a Notification of Notifiable
Device(s), a person upon whom the duty is imposed shall ensure that the change is notified in writing to
the local authority within one month after it’s occurrence. When a notifiable device ceases to be, and is no
longer intended to remain, a notifiable device, a person upon whom the duty is imposed shall as soon as is
reasonably practicable after the cessation ensure that the fact is notified in writing to the local authority.