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NSW Resources Regulator
FORM | WHS (MINES AND PETROLEUM SITES) LEGISLATION
Mine operator authorisation to supply mine survey planMay 2023
This form is to be used to authorise the supply of a mine survey plan to the regulator by the nominated mining surveyor.
Clause 127(1) of the Work Health and Safety (Mines) Regulation 2014 requires the operator of a mine to provide a copy of the mine survey plan to the regulator in the manner and form required by the regulator.
The statutory function of the mining surveyor is to prepare and certify the mine survey plan. The requirement for nomination to exercise the statutory function is that the individual nominated must be a registered mining surveyor within the meaning of the Surveying and Spatial Information Act 2002.
Details of mine operatorName
Email address
Postal address
Suburb Postcode
Business address (if different)
Suburb Postcode
Telephone Mobile
Details of the mineName of mine
Site address
Land title identification reference(s)
1
NSW Resources Regulator
Boundaries of all extraction and exploration sites (attach additional information if required)
Nominated mining surveyorName of nominated mining surveyor:
Board of Surveying and Spatial Information Identification Number (BOSSI No):
Nomination date:
Declaration by mine operatorI declare that:
I am authorised to make this declaration the nominated mining surveyor above is authorised to supply the mine survey plan to the regulator on
behalf of the mine operator the information supplied in this application is true and correct in every particular.
Name
Position/title
Signature Date
Submitting the form Email this form to [email protected]
© State of New South Wales through the NSW Department of Planning and Environment 2018.
This publication is copyright. You may download, display, print and reproduce this material in an unaltered form only (retaining this notice) for your personal use or for non-commercial use within your organisation. To copy, adapt, publish, distribute or commercialise any of this publication you will need to seek permission from the NSW Department of Planning and Environment.
Disclaimer: The information contained in this publication is based on knowledge and understanding at the time of writing (May 2023). However, because of advances in knowledge, users are reminded of the need to ensure that information upon which they rely is up to date and to check currency of the information with the appropriate officer of the NSW Department of Planning and Environment or the user’s independent advisor.
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