Request to Appoint Acting “JCU Authorised Officer
Delegated the Vice Chancellor’s Authority”
Health (Drugs and Poisons) Regulation 1996 (Qld)
Electronic copies of this form are current. All other copies are uncontrolled and currency can only be assured at the time of printing
Version: 1 Approval Date: 26/02/2016 Next Review Date: 25/02/2017 Page 1 of 1
This form is to be completed under guidance of James Cook University's Health, Safety and Environment Policy and
Procedures which can be viewed via
Authorised Officer’s Delegated the Vice Chancellor’s Authorityto purchase schedules 2, 3 and 4 drugs and poisons
are listed on the “Vice Chancellor’s Delegation of Authority”. When an Authorised Officer is absent from the University
the Acting Authorised Officer can be formally appointed to carry out the authorisation.
This authorisation does not extend to schedules 7, 8 and 9 that must be approved by a Drugs Officer. Drugs Officer
Approvals from Qld Health are awarded to a specific person not a role.
Incumbent Name
Incumbent Position Title
Incumbent Division
Acting Name
Acting Position Title
Acting Division
From Date To Date
Acting Authorised Officer Declaration
I, , agree to exercise my duty in accordance with Sections 179A and 265A of the Health
(Drugs and Poisons) Regulation 1996 (Qld) and JCU’s Health and Safety Management System, Drugs and Poisons
Procedure HSE-PRO-004
Health (Drugs and Poisons) Regulation 1996 (Qld)
Drugs and Poisons Procedure HSE-PRO-004
Acting Signature
Please submit signed form for Endorsement to the relevant delegate of your Division (Director, Divisional Operations or Dean, Research)
I, the undersigned, consider the above Acting Authorised Officer is an appropriately qualified officer, having the qualifications, experience or
standing appropriate to exercise the Vice Chancellor’s Delegation of Authority
Divisional Operations
Please submit signed form for Authorisation to the Vice Chancellor on email
Vice Chancellor
Please submit signed form for completion to the Health, Safety and Environment team on email
click to sign
click to edit
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