Western Australian Consolidated Regulations Western Australian Consolidated RegulationsForm 1
Western Australia
APPLICATION FOR A LICENCE TO USE AND CONDUCT
A CREMATORIUM
To His Excellency the Governor of Western Australia:
1. The trustees
and the controlling authority of the
.......................................
Cemetery, being a public cemetery
appointed under the Cemeteries Act 1897 2 (or the
............................................. being an association incorporated
under the Associations
Incorporation Act 1895
3, established and constituted in connection with the
cremation of dead human bodies, and holding a certificate under the hand of the
Executive Director that the association is an association to which the
provisions of section 4 of the Act may reasonably be extended), hereby
apply for a licence to use and conduct a crematorium under and in accordance
with the provisions of the Act, at and in the cemetery at the site next
mentioned.
2. The buildings to be used as the crematorium have been erected
upon (or will be erected upon) that portion of the area of the said cemetery
which has been defined and set apart by the trustees of the cemetery as a site
for the crematorium,
namely: —
.............................................................................................................................................
.............................................................................................................................................
and
shown on the attached plan.
3. This application is accompanied by the
statutory declaration of
................
...................................................................,
of ..................................................................,
in
the State of Western Australia,
............................................................... as required by
section 4(2) of the Act, and by the sum of
...................................... the fee for the licence hereby applied
for.
4. The applicant undertakes that within one year from the date on which
the licence is granted they (or it) will obtain the certificate of the Executive
Director, Public Health and Scientific Support Services required by
section 4(3) of the Act.
Dated the ....................................... day of
.......................................................... , 20.........
For and on behalf of the applicant,
...................................................................
Chairman.
[Form 1 amended in Gazette 29 Jun 1984 p. 1781.]
Form 2
Western Australia
LICENCE TO USE AND CONDUCT A SPECIFIED
CREMATORIUM
Whereas by an application bearing the
date................................................., day of
..............................., 20 ........,
.............................................................................................
.............................................................................................................................................
.............................................................................................................................................
being
the trustees duly appointed under the provisions of the Cemeteries
Act 1897 2, as the Trustees and controlling body of the
........................................................... Cemetery, a public
cemetery duly proclaimed under the provisions of the Cemeteries
Act 1897 2, applied to His Excellency the Governor in
Council for a licence under the provisions of the Cremation
Act 1929, to the trustees and controlling body of the said
........................ ................................... Cemetery, upon a
site thereon, as defined in the said application, and whereas the applicants
have satisfied His Excellency the Governor in accordance with the provisions of
section 4 of the Cremation Act 1929, that the said trustees or
controlling body of the said ..................................... Cemetery have
sufficient authority to use the proposed site in the said cemetery for the
purpose of a crematorium, that the crematorium not yet being established the
Executive Director, Public Health and Scientific Support Services has approved
of the plans and specifications of the proposed building, fittings, works and
apparatus to be built and used for the purposes of the said crematorium, and
that in all other respects the requirements of section 4 of the
Cremation Act 1929, have been duly complied with: Now, therefore,
His Excellency the Governor, acting with the advice and consent of the Executive
Council, and in exercise of the powers conferred by section 4 of the
Cremation Act 1929, doth by these presents grant to the trustees and
controlling body for the time being and from time to time of the
...................................... Cemetery, but subject as hereinafter
provided, a licence to use and conduct a crematorium within the said
....................................... Cemetery, upon the site therein defined
in the aforementioned application, to be established in accordance with the
plans and specifications of the proposed building, fittings, works, and
apparatus which have been approved by the Executive Director, Public Health and
Scientific Support Services as aforesaid: Provided that the licence hereby
granted shall be held and the said crematorium shall be used and conducted under
and subject to the provisions of the Cremation Act 1929, and that
the licence hereby granted shall not have any validity or effect unless and
until the Executive Director, Public Health and Scientific Support Services
shall certify within one year of the granting of this licence that the
buildings, fittings, works, and apparatus have been erected and installed in
accordance with the plans and specifications which have been approved by him as
aforesaid and that the regulations have been complied with.
Dated at Perth in the State of Western Australia this
..............................................
day of
...................................................., 20 ...........
By His Excellency’s Command,
....................................................................
Minister.
[Form 2 amended in Gazette 29 Jun 1984
p. 1781.]
Form 3
Western Australia
LICENCE TO USE AND CONDUCT A
SPECIFIED
CREMATORIUM
Whereas by an application bearing the date
................................................. day of
................................................. , 20 .......... ,
.......................................................................
.............................................................................................................................................
an
association duly incorporated under the provisions of the Associations
Incorporation Act 1895 3, for the purpose of conducting
a crematorium holding a certificate under the hand of the Executive Director,
Public Health and Scientific Support Services that the association aforesaid is
an association to which the provisions of section 4 may reasonably be
extended, applied to His Excellency the Governor in Council for a licence under
the provisions of the Cremation Act 1929, for the said association
to use and conduct a crematorium within the boundaries of land, not being part
of a public cemetery, being the whole (or portion) of
........................... lot/location .......................... comprised in
Certificate of Title Volume ......................, folio
........................., held by the said association for the purpose
aforesaid (or within the ........................... cemetery, a public cemetery
duly proclaimed under the provisions of the Cemeteries
Act 1897 2) upon a site thereon as defined in the said
application; and whereas the said applicants have satisfied His Excellency the
Governor, in accordance with section 4 of the Cremation
Act 1929, that the association has sufficient authority to use the
proposed site as aforesaid for the purpose of a crematorium, that the
crematorium has not yet been established, the Executive Director, Public Health
and Scientific Support Services has approved of the plans and specifications of
the proposed building, fittings, works and apparatus to be built and used for
the purposes of crematorium, and that in all other respects the requirements of
section 4 of the Cremation Act 1929, have been duly complied
with: Now, therefore, His Excellency the Governor, in exercise of the powers
conferred by section 4 of the Cremation Act 1929, doth by these
presents grant to the said association, but subject as hereinafter provided, a
licence to use and conduct a crematorium within the boundaries of the land (or
cemetery) as aforesaid, upon the site therein as defined in the application, to
be established in accordance with the plans and specifications of the proposed
building fittings, works, and apparatus, which have been approved by the
Executive Director, Public Health and Scientific Support Services as aforesaid:
Provided that the licence hereby granted shall be held and the crematorium shall
be used and conducted under and subject to the provisions of the Cremation
Act 1929, and that the licence hereby granted shall not have any
validity or effect unless and until the Executive Director, Public Health and
Scientific Support Services shall certify, within one year of the date on which
the licence is granted, that the necessary buildings, fittings, works and
apparatus have been erected and installed in accordance with the plans and
specifications which have been approved by him, and that the regulations have
been complied with.
Dated at Perth in the State of Western Australia, this
.............................................
day of
................................................... 20 .............
By His Excellency’s Command.
....................................................................
Minister for Health.
[Form 3 amended in Gazette 29 Jun 1984
p. 1781.]
Form 4
Western Australia
APPLICATION FOR CERTIFICATE OF EXECUTIVE
DIRECTOR,
PUBLIC HEALTH AND SCIENTIFIC SUPPORT SERVICES TO
GIVE
EFFECT TO A LICENCE GRANTED TO USE AND CONDUCT
A
CREMATORIUM
To the Executive Director, Public Health and Scientific Support
Services.
The trustees and controlling authority of the
........................................... cemetery (or the
............................................. ) being the licensees named in the
licence to use and conduct a crematorium on a site in the said cemetery, granted
under the provisions of the Cremation Act 1929, to the licensee on
............................................ hereby apply for your certificate
as required by section 4(3) of the Act, that the necessary buildings,
fittings, works and apparatus for the said crematorium have been erected and
installed in accordance with the approved plans and specifications and that the
relative regulations have been complied with.
The sum of ........................................... being the prescribed
fee accompanies this application.
Dated this ................................ day of
.........................................., 20 ........
For and on behalf of the applicant.
..............................................................
Chairman.
[Form 4 amended in Gazette 29 Jun 1984
p. 1781.]
Form 5
Western Australia
CERTIFICATE OF THE EXECUTIVE DIRECTOR, PUBLIC
HEALTH
AND SCIENTIFIC SUPPORT SERVICES GIVING EFFECT TO
A
LICENCE TO USE AND CONDUCT A CREMATORIUM
Whereas a licence to use and conduct a crematorium upon a site defined and
set aside for the purpose within the
...................................................... cemetery was on the
............................................... granted under the provisions of
the Cremation Act 1929, to
....................................................................................................................................
and whereas it is provided that the licence shall not have any validity or
effect unless and until the Executive Director, Public Health and Scientific
Support Services shall certify within one year from the granting of the licence
that the necessary buildings, fittings, works and apparatus have been erected
and installed in accordance with the approved plans and specifications, and that
the relative regulations have been complied with: Now, therefore, I
.....................................................................................
Executive Director, Public Health and Scientific Support Services do hereby
certify that the buildings, fittings, works and apparatus have been duly erected
and installed, in accordance with the approved plans and specifications, at the
site mentioned in the licence, and that the relative regulations have been
complied with.
Dated the ................................ day of
..............................................., 20 ...............
....................................................................
Executive Director,
Public Health and
Scientific
Support Services.
[Form 5 amended in Gazette 29 Jun 1984
p. 1781.]
Form 6
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Application for Permit to Cremate |
Form 6 |
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Applicant |
Name |
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Address |
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Deceased |
Name |
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Address |
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Date of birth / / Male/Female |
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Marital status |
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Occupation |
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(*“Nearest surviving relative” is explained at the end of
this form.) |
Nearest surviving relative* (if known) Name Relationship |
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Usual doctor Name Address |
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Doctor(s) who attended deceased during his or her last illness Name Address |
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Instructions from deceased |
Did the deceased leave any written directions about how his or her remains
were to be dealt with? No Yes. Give details |
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Objections |
Do you know of anyone who objects to the deceased’s remains being
cremated? No Yes. Give detail of that person: Name Relationship to deceased
__________________________ Relationship to deceased Address |
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Coroner |
Has the Coroner conducted an investigation or inquest into the
deceased’s death? |
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Applicant’s relationship to deceased (*“Nearest surviving relative” is explained at the end of
this form.) |
Administrator of the deceased Nearest surviving relative* of the deceased Other If you are not the Administrator, why are you making the application
instead of the Administrator? |
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Details of death |
Date / /20 Time
a.m./p.m. |
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Place where deceased died Home Address Hospital Address Other Address |
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Do you know, or have reason to suspect, that the deceased’s death was
directly or indirectly due to any of the following? (tick if
yes) violence poison privation or neglect medical procedure drowning suffocation burns |
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Do you have any reason to suppose that an examination of the
deceased’s remains may be desirable? No Yes. Give details |
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Other applications |
Have you, or anyone else that you know of, previously applied for a
permit to cremate the deceased’s remains? No Yes. Give details of previous application Made by Date _______/_______/20 _____ Medical Referee to whom it was
made |
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Statutory declaration |
I sincerely declare that the information given in this application is
true and correct and that I have not omitted any relevant information.
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Signature |
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Date / /20 |
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(Witness must be a person authorised to take statutory
declarations.) |
Witness |
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Signature |
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Name |
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Address |
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Medical referee (For office use only) |
Permit No. |
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Date / /20 |
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Medical Referee |
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Signature |
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Name |
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The nearest surviving relative of a deceased person, is the first
person who is available from the following persons in the order of priority
listed — (a) a person who, immediately before the death, was living as —
(i) the spouse of the deceased; or (ii) a de facto partner of the deceased and who is at least 18 years
of age; (b) a person who, immediately before the death, was the spouse of the
deceased; (c) a son or daughter of the deceased who is at least 18 years of
age; (d) a parent of the deceased; (e) a brother or sister of the deceased who is at least 18 years of
age. |
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[Form 6 inserted in Gazette 4 Apr 2008
p. 1300‑2.]
Form 7
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Certificate of Medical Practitioner |
Form 7 |
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Certificate to be completed by doctor who attended deceased
prior to death. Add additional pages if more space is
required. Attach copies of all relevant laboratory reports, results,
certificates etc. |
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Deceased |
Name |
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Address |
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Date of birth / / Age |
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Marital status |
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Male/Female |
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Occupation |
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Doctor |
Name |
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Address |
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Are you a spouse, de facto partner or relative of the deceased? No Yes Nature of relationship __________________________ |
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As far as you are aware, do you have a pecuniary interest in the
deceased’s estate or any other pecuniary interest in the deceased’s
death? No Yes Give details _________________________________ |
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Were you the deceased’s usual doctor? No Yes |
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Recent care of deceased |
During the 4 weeks prior to death did the deceased receive medical or
nursing care? No Yes Where was the deceased cared for? Hospital Nursing home Home Other If cared for at home or other place, who provided care? Professional health care providers Relatives, friends, others Give names and relationship to the deceased |
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Did you attend the deceased during his or her last illness? No Yes Since what date? / /20 |
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Did any other doctor(s) attend the deceased during his or her last
illness? No Yes Give names |
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Last illness |
Brief clinical history of last illness including diagnoses and events
leading to death. ______________________________________________________________________________________________________________ |
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Details of death |
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Place where the deceased died — Home Address _________________________________________ Hospital _________________________________________ Address _________________________________________ Other ___________________________________________ Address _________________________________________ |
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Were you present when the deceased died? Yes No When did you last see the deceased alive? Date / /20 Time
a.m./p.m. |
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Did you examine the deceased’s body after death? No Yes Give details |
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Do you have any reason to suppose that a further examination of the
deceased’s remains may be desirable? No Yes Give details |
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Cause of death |
Was a post mortem performed? No Yes Give details of results |
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(* If a Medical Certificate of Cause of Death is attached, answers are
not required to these questions.) |
*Did you sign the Medical Certificate of Cause of Death? Yes No Name of the doctor who signed the certificate |
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*Direct cause of death |
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*Antecedent causes of death (if any) |
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*Conditions contributing to or accelerating death (if any) |
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Clinical observations |
Do you know, or have reason to suspect, that the deceased’s death was
directly or indirectly due to any of the following? (tick if
yes) violence poison privation or neglect medical procedure drowning suffocation burns |
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In view of the deceased’s lifestyle and health, do you have
any doubts about the character of the deceased’s illness or cause of
death? No Yes Give details |
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Safety of cremation |
At the time of death was the deceased fitted with a cardiac
pacemaker? No Yes Has it been removed Yes No |
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Had the deceased received any of the following radioactive
treatments? • Strontium‑89 injection (e.g. for bone metastases)
No Yes* • Iodine‑125 seed implant (e.g. for prostate cancer)
No Yes* • Samarium‑153 during the 2 weeks prior to death No Yes* • Rhenium‑188 during the 2 weeks prior to death No Yes* • Yttrium‑90 during the 2 weeks prior to death No Yes* * If yes — has the Radiation Safety Officer at the treating
institution certified that cremation is safe? No Yes Attach certificate |
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Are you aware of anything else that could render cremation unsafe? (e.g.
other medical devices, recent treatment etc.) No Yes Give details |
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Certification of medical practitioner |
I certify that the information set out above is true and correct and
that I have not omitted any relevant information. |
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Signature |
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Date / /20 |
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[Form 7 inserted in Gazette 4 Apr 2008
p. 1302‑4.]
Form 8
Western Australia
CORONER’S CERTIFICATE
I am informed that application is to be made for a permit to cremate in
regard to the deceased person whose particulars are set out
hereunder: —
Name of deceased .............................................. Age
............... Sex ......................
Date of death
..................................Place of death
..........................................................
It has been reported that the cause of death was (primary)
.....................................
.............................................................................................................................................
(secondary)
.........................................................................................................................
I certify that in my opinion the cause of death was as stated. I consider
that no circumstance exists which can render necessary any further examination
of the body, and that there is no reason why the body should not be
cremated.
Dated at ......................................this
.......................... day of ................. 20 ..........
....................................................................
Coroner.
Form 9
Western Australia
PERMIT TO CREMATE
No .................................
I,
.............................................................................................................,
a medical referee appointed under section 8 of the Cremation
Act 1929, acting pursuant to the powers and duties vested in me under
the said Act and having received an application from
.............................................., of
........................................., for a permit to cremate the remains
of: —
Name of deceased
...................................................................................................,
late of
..................................................................................................................
(address in full), who died at
.................................................................................................(place
of death) on .................................................................
(date of death), hereby permit and authorise the cremation at any duly licensed
crematorium in the State of Western Australia.
This permit shall not be valid until 24 hours have elapsed from the
time of death of the deceased person to whom the permit refers.
Dated this ....................................... day of
.............................................., 20.........
....................................................................
Medical Referee.
Form 10
Western Australia
NOTICE OF REFUSAL OF APPLICATION
TO
CREMATE
To .............................................................., of
...................................................................
I hereby give you notice that the application made by you for a permit to
cremate the remains of
...................................................................................
(name of deceased), late of
..............................................................................................
(address), who died at
.................................................................................................................
(place of death) on
.............................................................................................
(date of death) is refused.
This refusal has been made known to the Executive Director, Public Health
and Scientific Support Services, together with the reasons therefor. You may
apply to the State Administrative Tribunal for a review of the
decision.
....................................................................
Medical Referee.
[Form 10 amended in Gazette 29 Jun 1984 p. 1781;
30 Dec 2004 p. 6933.]
Form 11
Western Australia
REGISTER OF CREMATIONS
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Method of Disposal
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1. Place of |
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Form 12
Western Australia
CERTIFICATE OF CREMATION
To the Executive Director, Public Health and Scientific Support Services
and the Registrar General:
I, ............................................... (name), of
............................................ (address), in the State of Western
Australia, being the .......................................... (title of
position) ...........................................................
(licensee), the licensee of the .................................. Crematorium,
.................................(place) do hereby certify that the body
of................... (name of person cremated), late of
.....................................................................................
(address of person cremated), who died on
............................................... (date of death) was, in
pursuance of Permit No. ....................................................
issued by ................... (medical referee) to
....................................................... (name of permit holder),
of
....................................................................................
(address of permit holder) duly cremated in the said crematorium on the
............................................................... (date) under and
in accordance with the provisions of the Cremation
Act 1929.
....................................................................
Signature.
Date ................................................
[Form 12 amended in Gazette 29 Jun 1984
p. 1781.]
Form 13
CERTIFICATE OF MEDICAL PRACTITIONER WHO
HAS
CONDUCTED A POST MORTEM EXAMINATION
I,
..................................................................................................legally
qualified medical practitioner, being informed that application is about to be
made for a permit to cremate the body of (name)
..................................................................................................,
late of (address)
.............................................................................................................................,
(occupation)
.....................................................................................
hereby certify that on (date)................................................,
at (place) .................................................................,
I made a post mortem examination of all the vital organs of the deceased,
and I am of the opinion as a result of such examination that the death of the
deceased resulted from natural causes, as
follows: —
.............................................................................................................................................
.............................................................................................................................................
.............................................................................................................................................
.............................................................................................................................................
Signature ...................................................
Address
.....................................................
Qualifications
............................................
Date ................................................
No person who knows that under the terms of any policy of life assurance,
will, settlement, or statute or otherwise howsoever he is entitled or will
become entitled by reason or in consequence of the death of another person to
any real or personal property shall give or sign any certificate concerning the
death of such other person for any of the purposes of this Act.
[Form 13 inserted in Gazette 17 Dec 1954 p. 2252.]
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$ |
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For a licence to use and conduct a crematorium ..........................
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15.00 |
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For a certificate of the Executive Director to validate and give effect to
a licence, including inspections .....................................
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For a permit to cremate — |
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(a) given between the hours of 9 a.m. and 5 p.m., Monday to
Friday inclusive, or 9 a.m. and noon on a Saturday (public holidays
excluded) ...................... |
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(b) given at any other time .............................................
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94.00 |
[Appendix “B” inserted in Gazette 16 Nov 1973
p. 4220; amended in Gazette 28 May 1976 p. 1579;
29 Jun 1984 p. 1781; 28 Dec 1984 p. 4206;
27 May 1994 p. 2209; 29 Mar 1996 p. 1580;
2 Apr 1996 p. 1580; 30 Jun 2000 p. 3406;
13 Apr 2010 p. 1373.]
1 This is a compilation of the Cremation
Regulations 1954 and includes the amendments made by the other written
laws referred to in the following table 1a. The table also
contains information about any reprint.
|
Citation |
Gazettal |
Commencement |
|---|---|---|
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20 Aug 1954 p. 1441‑9 |
6 Sep 1954 (see r. 2) |
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Untitled regulations |
17 Dec 1954 p. 2252 |
17 Dec 1954 |
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Reprint of the Cremation Regulations 1954 in
Gazette 15 Sep 1959
p. 2339-50 |
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Decimal Currency Act 1965 assented to
21 Dec 1965 |
Act other than s. 4‑9: 21 Dec 1965 (see
s. 2(1)); |
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Untitled regulations |
16 Nov 1973 p. 4220 |
16 Nov 1973 |
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Untitled regulations |
28 May 1976 p. 1579 |
28 May 1976 |
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Untitled regulations |
24 Feb 1978 p. 560‑1 |
24 Feb 1978 |
|
Health Legislation Amendment Regulations 1984
r. 4 |
29 Jun 1984 p. 1780‑4 |
1 Jul 1984 (see r. 2) |
|
Cremation Amendment Regulations
1984 4 |
28 Dec 1984 p. 4206 |
28 Dec 1984 |
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Cremation Amendment Regulations 1994 |
27 May 1994 p. 2209 |
27 May 1994 |
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Cremation Amendment Regulations 1996 |
2 Apr 1996 p. 1579‑80 |
2 Apr 1996 |
|
Miscellaneous Amendments Regulations 1997
r. 2 |
6 Jan 1998 |
6 Jan 1998 |
|
Cremation Amendment
Regulations 2000 |
30 Jun 2000 p. 3406 |
1 Jul 2000 (see r. 2) |
|
Reprint of the Cremation Regulations 1954 as at 1
Dec 2000 (includes amendments listed above) |
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Cremation Amendment
Regulations 2002 |
24 Sep 2002 p. 4766‑8 |
24 Sep 2002 5 |
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Cremation Amendment
Regulations 2004 |
30 Dec 2004 p. 6933 |
1 Jan 2005 (see r. 2 and Gazette
31 Dec 2004 p. 7130) |
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Cremation Amendment
Regulations 2008 |
4 Apr 2008 p. 1299‑304 |
1 Jul 2008 (see r. 2) |
|
Reprint 3: The Cremation Regulations 1954 as at 1
Aug 2008 (includes amendments listed above) |
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Cremation Amendment
Regulations 2010 |
13 Apr 2010 p. 1373 |
r. 1 and 2: 13 Apr 2010 (see
r. 2(a)); |
2 Repealed by the Cemeteries Act 1986.
3 Repealed by the Associations Incorporation
Act 1987.
4 The Miscellaneous Regulations (Validation)
Act 1985 applied to these regulations. It deems the regulations not to
have ceased to have effect as a result of the failure to comply with
section 42(1) of the Interpretation Act 1984, subject to their
being laid before the Legislative Assembly. The Interpretation
Act 1984 s. 42(2) then applied as if the words “or if any
regulations are not laid before both Houses of Parliament in accordance with
subsection (1)” had been omitted.
5 The commencement date referred to in r. 2 was before the
date of gazettal.
Defined
Terms
[This is a list of terms defined and
the provisions where they are defined. The list is not part of the
law.]
Defined Term Provision(s)
nearest
surviving relative 3