PP59 - Mobile Polling Place Team Return

PP59

Mobile Polling PlaceTeam Return

District
Mobile team number / Date of election / 11/3/2017
Names of Mobile Polling Places/Venues
1
2
3
4
5
6
7
8
9
10
11
12
I certify that the enclosed returns are correct and that a list enclosed includes details of any postal ballot envelopes containing ballot papers received by me before the close of the poll. I also certify that, to the best of my knowledge, this election has been conducted independently and impartially and that, to the best of my understanding and ability, I have performed all the duties of my office, lawfully and professionally and acted at all times with fairness, honesty and integrity.
/ 3 /2017
Signature of Mobile Polling Place Manager / Date

This form is to be provided to the Returning Officer for return to the WAEC with the Polling Place Manager General Return (PP44)

58636_9 27/01/17 1

PP59

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58636_9 27/01/17 1

PP59

Mobile Polling Place Team Return

Contents / Page
Record of Ballot Box Security Seal Numbers / 5
Appointment of Substitute Mobile Polling Place Manager / 9
Reconciliation of All Ballot Papers – Assembly and Council / 11
Summary of Declaration Votes / 12
Mobile Polling Place Accident Report / 13
Report on Incidents and Miscellaneous Matters / 15
Additional Forms to be Inserted in this Return / 17

PP59

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PP59

Record of Ballot BoxSecurity Seal Numbers

First Mobile Polling Place Visited
Mobile polling place number / Commencement of Polling / Close of Poll
Ballot box numbered was displayed empty and then sealed with the security seal A. / The voting slot was covered and sealed with security seal B.
Seal A number
Mobile Polling
Place Manager ______
Witness ______/ Seal B number
Mobile Polling
Place Manager ______
Witness ______
Subsequent Mobile Polling Place Visited
Mobile polling place number / Commencement of Polling / Close of Poll
The security seals A and B were examined and verified.
The seal B on the voting slot was broken. / The voting slot was covered and sealed with security seal B.
Mobile Polling
Place Manager ______
Witness ______/ Seal B number
Mobile Polling
Place Manager ______
Witness ______
Mobile Polling
Place Manager ______
Witness ______/ Seal B number
Mobile Polling
Place Manager ______
Witness ______
Mobile Polling
Place Manager ______
Witness ______/ Seal B number
Mobile Polling
Place Manager ______
Witness ______

Record of Ballot BoxSecurity Seal Numbers

First Mobile Polling Place Visited
Mobile polling place number / Commencement of Polling / Close of Poll
Ballot box numbered was displayed empty and then sealed with the security seal A. / The voting slot was covered and sealed with security seal B.
Seal A number
Mobile Polling
Place Manager ______
Witness ______/ Seal B number
Mobile Polling
Place Manager ______
Witness ______
Subsequent Mobile Polling Place Visited
Mobile polling place number / Commencement of Polling / Close of Poll
The security seals A and B were examined and verified.
The seal B on the voting slot was broken. / The voting slot was covered and sealed with security seal B.
Mobile Polling
Place Manager ______
Witness ______/ Seal B number
Mobile Polling
Place Manager ______
Witness ______
Mobile Polling
Place Manager ______
Witness ______/ Seal B number
Mobile Polling
Place Manager ______
Witness ______
Mobile Polling
Place Manager ______
Witness ______/ Seal B number
Mobile Polling
Place Manager ______
Witness ______

Record of Ballot BoxSecurity Seal Numbers (continued)

Mobile polling place number / Commencement of Polling / Close of Poll
The security seals A and B were examined and verified.
The seal B on the voting slot was broken. / The voting slot was covered and sealed with security seal B.
Mobile Polling
Place Manager ______
Witness ______/ Seal B number
Mobile Polling
Place Manager ______
Witness ______
Mobile Polling
Place Manager ______
Witness ______/ Seal B number
Mobile Polling
Place Manager ______
Witness ______
Mobile Polling
Place Manager ______
Witness ______/ Seal B number
Mobile Polling
Place Manager ______
Witness ______
Mobile Polling
Place Manager ______
Witness ______/ Seal B number
Mobile Polling
Place Manager ______
Witness ______
Mobile Polling
Place Manager ______
Witness ______/ Seal B number
Mobile Polling
Place Manager ______
Witness ______
Mobile Polling
Place Manager ______
Witness ______/ Seal B number
Mobile Polling
Place Manager ______
Witness ______

Record of Ballot BoxSecurity Seal Numbers (continued)

PP59

Appointment of SubstituteMobile Polling Place Manager

Electoral Act 1907, s.105

To
Name of Substitute Mobile Polling Place Manager

You are appointed to act as Substitute Mobile Polling Place Manager while I am temporarily absent from the mobile polling place.

During my absence you are deemed to be the Mobile Polling Place Manager and may exercise
all the powers of the position.

/ /2017
Signature of Mobile Polling Place Manager / Date

I acknowledge the appointment

/ /2017
Signature of Substitute
Mobile Polling Place Manager / Date
Record of Times Acting as Substitute Mobile Polling Place Manager
Day / Date / From / To

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PP59

Reconciliation of All Ballot Papers

Mobile polling places / 1 / 2 / 3 / 4 / 5 / 6
ALL Ballot Papers on Hand at Start of Poll / Spoilt / Issued to Ordinary Voters / Issued to
Declaration Voters
(PP25 or PP90) / Unused
(1-2-3-4=5)
Transfer figure to column 1 on next line / Discarded
Totals / *
Balance of Ballot Papers / Assembly
1 / Number of ordinary ballot papers issued to electors (total column 3 above)
2 / Number of spoilt ballot papers (total column 2 above)
3 / Number of unused ballot papers (last entry in column 5 above)
4 / Total number of completed PP25 Declaration Vote envelopes or PP90 ERS envelopes in the ballot box (total column 4 above)
5 / Total (rows 1 + 2 + 3 + 4 = 5)
6 / Total number of ballot papers received from Returning Officer
(first line of column 1 above – all ballot papers on hand at start of poll)
7 / Difference (row 6 - 5) / **
8 / Number of discarded ballot papers (total column 6 above)

** If the difference is greater than 3, refer to instructions Reconciliation of Ballot Papers in your manual

PP59

Summary of Declaration Votes

District / Number of PP90 ERS Envelopes (from PP56) / Number of PP25 Envelopes
(from PP56) / Early Votes
(by post) / District / Number of PP90 ERS Envelopes (from PP56) / Number of PP25 Envelopes
(from PP56) / Early Votes
(by post)
Albany / Subtotal
Armadale / Kingsley
Balcatta / Kwinana
Baldivis / Mandurah
Bassendean / Maylands
Bateman / Midland
Belmont / Mirrabooka
Bicton / Moore
Bunbury / Morley
Burns Beach / Mount Lawley
Butler / Murray-Wellington
Cannington / Nedlands
Carine / North West Central
Central Wheatbelt / Perth
Churchlands / Pilbara
Cockburn / Riverton
Collie-Preston / Rockingham
Cottesloe / Roe
Darling Range / Scarborough
Dawesville / South Perth
Forrestfield / Southern River
Fremantle / Swan Hills
Geraldton / Thornlie
Girrawheen / Vasse
Hillarys / Victoria Park
Jandakot / Wanneroo
Joondalup / Warnbro
Kalamunda / Warren-Blackwood
Kalgoorlie / West Swan
Kimberley / Willagee
Subtotal / Totals / *

* Combined total must agree with total PP25 and PP90 declaration envelopes on page 11 row 4

PP59

Mobile Polling Place Accident Report

To be completed by the Mobile Polling Place Manager in the event of any accident causing an injury to any person attending a polling place.

Mobile polling place
Details of Injured Person
Full name
Address / Postcode
Telephone / Fax / Mobile
Status / Elector / Accompanying elector / Staff member
Polling Place Facilities
Site of accident / Inside building / YES NO
Please provide accurate sketch of accident site on back of this form
Conditions / Raining/wet: / YES NO
Detail any obstructions (i.e. bins)
Were there any warning signs of obstructions erected? / YES NO
Floor conditions / Slippery / YES NO / Details
Actions of Injured Person
Distance walked from street entrance to site of injury
Time of injury / Time / AM PM / On the way to vote
On way out from voting / YES NO
YES NO
Was the person / Carrying anything? / YES NO / Alone / YES NO
What sort of footwear was the person wearing?
Did the person need to sit down to recuperate / YES NO / If so, for how long?
Describe location and severity of injury
Was medical attention sought? / YES NO / From whom?
Other Details
Were there any witnesses? / YES NO / List names and contact details on back of this form
Were statements obtained from witnesses? / YES NO / Please attach to this form
Did the injured person appear to be effected by drugs or alcohol? / YES NO

Name (please print) Signature of Mobile Polling Place Manager

continue over if required

Mobile Polling Place Accident Report

Mobile Polling place

Sketch of Accident Site

Complete a written statement outlining the sequence of events leading up to and following the incident and include any relevant information not already covered on this form.

PP59

Report on Incidents andMiscellaneous Matters

Mobile Polling place
Include:
· any incident reported to the Polling Place Manager or polling staff
· complaints from electors or scrutineers
· any other matters which should be brought to the attention of the Returning Officer

continue over if required

Additional Forms to be Inserted in this Return
These forms are to be inserted into this return.
PP16 Scrutineers Appointment and Declaration form
PP35 Declaration by an elector who has not received an early ballot paper
Confirmation of Employment
Other______
As specified by the Returning Officer