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									Health and Safety




HSR AND DEPUTY HSR NOMINATION FORM
I,
(Full Name)
Being an employee of the University of Canberra, wish to nominate for the position of:

                            Health and Safety Representative


                            Deputy Health and Safety Representative


(Tick one box only)

For the Designated Work Group specified:

I declare that I am a member of the Designated Work Group specified above.

Signed:

Date:
         (d/MM/yyyy)


This nomination form must reach the office of the Returning Officer:

Warwick Bennett
Health & Safety Manager
Human Resources
SCA2

By 4:00pm on Tuesday 15th March 2011

An electronic copy of this statement, if provided, must be forwarded to
HealthSafety@canberra.edu.au

If more nominations are received than the number of vacancies, a ballot will be held. In this
instance eligible voters will be advised on Friday 18th March 2011 of the need for an election.
Ballot papers will be available to all eligible voters. Votes must be cast by 4:00pm on Friday 25th
March 2011.




OHS.002.3                       UC HSR & Deputy HSR Nomination form.doc2008Jun                                           Page1 of 1
Document Custodian:    Health & Safety              Date of last review:   Aug 2011               Date of Next review:     Feb 2014
              Hardcopies of this document are considered uncontrolled please refer to UC website for latest version

								
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