First Aid Officer Request Form

FIRST AID OFFICER REQUEST FORM

OBJECTIVE

The objective of the first aid request form is to determine:

1)If there isrequirement new FirstAid Officer in the workplace.

2)If retraining is required following the expiry of a First Aid Officer certification.

INSTRUCTIONS

Before completing the first aid request form we recommend reading the First Aid Policy and Guideline to assist in understanding the requirements and responsibilities.

Once the form is completed please forward to .

REQUESTOR DETAILS

Requestor Name: ______Position: ______

Phone Number:______Local Area: ______

IDENTIFY THE EXISTING FIRST AID OFFICERS

Identify the number and location of First Aid Officers near or in your area using the list on the intranet here. Alternatively consult with workers and First Aid Officers in your area.

IDENTIFIED FIRST AID OFFICERS CLOSEST TO YOU

Name: / Extn No: / Bld/Room No:
Name: / Extn No: / Bld/Room No:
Name: / Extn No: / Bld/Room No:

FIRST AID OFFICER REQUIREMENT

It is recommended that there be one First Aid Officer for every 50 workers in low risk work areas, or one First Aid Officer for every 25 workers in high risk work areas.

Guidance on what is considered a low or high risk work area can be found in the First Aid Guideline Section 4.2.4. If you are unsure if your area is considered low or high risk, we recommend conducting a risk assessment and consulting with the Safety & Employment Relations team.

Noting the information from the First Aid Policy and Guideline and the identification of current First Aid Officers,is First Aid Training required?Yes / No (select)

PROPOSED UNIVERSITY FIRST AID OFFICER

If you are nominating to be a University First Aid Officer please sign below that you agree to the responsibilities of a University First Aid Officer as outlined in the First Aid Policy and Guideline.

After approval by the Safety and Employment relations team and your Supervisor it is the responsibility of the proposed First Aid Officer to book their training via and provide them with the following:

Full Name, Date of Birth, Email, Contact Number, Course name and date, course location and USI (if applicable).

The course information can be found at the following link:
St Johns One Day Provide First Aid Course
Please request St John Ambulance to forward a copy of the invoice to for payment.

Proposed First Aid Officer Name: ______Position: ______

Location (Campus, Building & Room Number):______

Signed: ______Date: ______

SUPERVISOR APPROVAL OF THE APPLICATION

The application for this employee to undertake the role of a University FirstAid Officer is approved.

Supervisors Name: ______Position: ______

Signature: ______

SAFETYAND EMPLOYMENT RELATIONS

The first aid application has been reviewed by a Safety and Employment Relations representative and is considered acceptable / not acceptable. The appropriate first aid register has been updated Yes / No.

SER Team Members Name: ______Signature: ______