Fillable HSE PRO 010b Health Safety Representative Resignation Form (James Cook University of North Queensland)

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HSE PRO 010b Health Safety Representative Resignation Form (James Cook University of North Queensland)

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The HSE PRO 010b Health Safety Representative Resignation Form (James Cook University of North Queensland) form is 1 page long and contains:

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  • 11 check-boxes
  • 6 other fields

Country of origin: AUSTRALIA
File type: PDF

Australia forms for James Cook University of North Queensland

BROWSE JAMES COOK UNIVERSITY OF NORTH QUEENSLAND FORMS

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HSE-PRO-010b JCU HSR Resignation Form
Version: 1 Approval Date: 27/6/2016 Next Review Date: 27/6/2018 Page 1 of 1
I
insert name hereby formally resign
from my position as the Health and Safety Representative for
insert work group name
effective
insert date
The reason for my resignation is:
☐ No longer employed by / within the work group for which I was elected
☐ Resigned from JCU
☐ Other (please provide details below)
Signature of HSR Date
Handover Checklist (to be completed by resigning HSR)
☐ Clear contact details from any internal documentation e.g. posters, Division / Directorate / College website
☐ Incident investigations / workplace inspections - finalise or handover any outstanding items
☐ Formally notify work group of resignation
☐ Email this form to safety@jcu.edu.au
This section to be completed by HSE Unit
Name of HSE representative processing resignation
☐ Update HSR list
☐ Updated HSR list published to HSE website and forwarded to WHSQ
☐ Formal invitation for HSR nominations to work group (if applicable)
☐ Save completed form in TRIM
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HSE PRO 010b Health Safety Representative Resignation Form (James Cook University of North Queensland)

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Completed 18 July 2020

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