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Guidelines - Personal Information Consent Form
The Personal Information Consent Form is provided by Legal Services for completion by University staff when
taking, collecting and using photographs, films or quotations of individuals. The Personal Information Consent
Form is only intended to address the University's privacy obligations in relation to the individual being
photographed, filmed or quoted.
Photographs/films/quotations of individuals can be identifiable and are therefore personal information. When
taking/collecting and using individuals photographs, films or quotations, the University has certain privacy
obligations under the Personal Information Protection Act 2004 (Tas).
Among other things, the University must take any reasonable steps necessary to ensure individuals are aware of
certain matters when they are providing their personal information, including:
• The purposes of collection and intended recipients of the information; and
• Their right of access to the information, as well as the University's identity and relevant contact details.
The University cannot use or disclose personal information for any purpose other than what is set out in the
Purpose and Use description on this form (except in certain limited circumstances). Please contact Legal
Services before making any use of the photographs/films/quotations or other personal information not
specifically covered by the individual's consent on this form.
The collection and use of photographs, films or quotations by the University also potentially raises copyright
issues that must be considered. Copyright is owned by the University if the collection of photographs/
films/quotations is undertaken by a University staff member in the course of their employment, however if you
have any queries in relation to Copyright, please contact the University copyright office.
If the photographs/films/quotations are to be taken/collected by someone else, or if the photographs already
exist, please seek the assistance of Legal Services so that the University can ensure it obtains the rights it needs
to use the photographs/films/quotations.
The highlighted parts are to be completed by the staff member as follows:
Box 1 UTAS staff member to provide a description which is clear and accurate so the individual understands
why the University is taking/collecting their photograph(s)/film(s)/quotation(s), how it will be used and
to whom it will be disclosed. If the material is to be disclosed outside Tasmania or on the internet, this
should be made clear in the description.
Box 2 Clearly describe any other personal information that will be used and disclosed with the material.
Box 3 Add appropriate UTAS contact and organisational unit details – this should be someone who can
respond to queries in relation to the material.
If you require any other modifications to the form, or advice on particular issues raised by your activity, please
contact Legal Services.
******** REMOVE THESE GUIDELINES ONCE FORM COMPLETED BY STAFF MEMBER ********
Personal Information Consent Form
Personal Information Consent Form
I ..................................................................................................................................................................
[Insert name]
o
f ..................................................................................................................................................................
[Insert address]
Have read, understand and agree to the following:
1. I understand that I will be photographed/filmed/interviewed by the University of Tasmania (“the
University”) and by doing so, I will be providing the University with Personal Information (as defined in the
Personal Information Protec
tion Act 2004 (Tas)).
2. I understand that I will be photographed/filmed/interviewed and that this information will be collected by
the University for the purposes indicated in Box 1 – Purpose and Use.
3. I understand that I will be photographed/filmed/interviewed by the University and that the photograph(s)/
films/quotations will be used and disclosed by the University for the purposes as outlined in Box 1.
4. I consent to the use and disclosure of the photograph(s)/film(s)/quotation(s) as described in this form,
including any disclosure of the photograph(s)/film(s)/quotation(s) outside Tasmania or on the internet for
the purpose in Box 1.
5. I also consent to the use and disclosure of my other personal information (described in Box 2 below) with
the photograph(s)/film/quotation. Except as identified in Box 2, my name and address are otherwise only
collected on this form as a means of obtaining my valid consent.
6. I may contact the University in relation to my personal information using the details set out in Box 3 below.
If I am not provided with the Personal Information which the University holds on me, I have the right to
access my Personal Information held by the University in accordance with the Right to Information Act 2009.
7. I have read and understand how the University collects, holds, uses and discloses Personal Information as
set out in the UTAS Privacy Policy – available at:
http://www.utas.edu.au/__data/assets/pdf_file/0005/1162175/Privacy-Policy.pdf
BOX 1 – PURPOSE AND USE
The photograph(s)/film/quotation will be used in various electronic and hardcopy material, including the
internet, as part of the University’s activities
Promotions for the University of Tasmania, with a focus on the Australian Maritime
College. Examples include digital student recruitment campaigns, printed material, and
social media posts.
Personal Information Consent Form
BOX 2 – OTHER PERSONAL INFORMATION
I agree to my name being used and disclosed with the material: Yes
I understand that the photographs may be used without my name, even if I tick this box.
BOX 3 – HOW TO CONTACT THE UNIVERSITY OF TASMANIA
Signed: .......................................................................... Date: ....................................................................... …
Consent of Parent/Guardian (if under 18)
Signed: .......................................................................... Date: ....................................................................... ….
Name of Guardian: ………………………………………………………………………
Any quotes or comments that are gathered to support the use of the image. The subjects
name and course they are studying. Name of the facilities, and what they are used for.
James Fagg
Marketing Manager - College of Sciences and Engineering
james.fagg@utas.edu.au
(03) 6226 1809
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Completed 16 October 2020

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