Safety role nomination form

Please complete and submit this form if you have been appointed to a safety position in your work area.

Form fields marked with an asterisk (*) are mandatory.

First name:
Surname:
Email address: *
Department/School/Unit:
Faculty/Division:
Campus:
Phone number:
I have been appointed to the role of:	Safety Officer Deputy Safety Officer OHS&E Committee Chair Radiation Safety Officer Deputy Radiation Safety Officer First Aid Co-ordinator Biosafety Officer Laser Safety Officer
Specify areas (ie departments/divisions) which you will be covering:
NOTE: For all Health & Safety Representative nominations, please complete the Health and safety representative/ deputy health and safety representative nomination form
Approval by my Head of Department/Unit/Supervisor:
Authorised by (name): *
Authoriser's telephone:
Declaration (please tick): *	My supervisor has approved the above appointment