Safety role appointment form

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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.

                      

                      

                          

                  

     

                  

                              

                    

I have been appointed to the role of: *      

      

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:

      

            

Declaration (please tick) *