Safety and Health Representative (SHR) Nomination Form – Curtin University

In order to qualify for nomination as a SHR under the Occupational Safety & Health Act 1984, you will need to be a current employee of Curtin University. There is a reasonable expectation that the successful nominee will complete the two year term and it is also preferable that you are a fixed term or permanent staff member who can be available during most business hours to fulfil your SHR functions. If you are not fixed term, permanent or full-time, please discuss this with your area management, Health and Safety Sub-Committee members or contact the Health and Safety department to discuss your specific situation further.

I, ______hereby nominate

Nominator (Name in full)

______for the position of Safety and Health Representative in the following area:

Nominee (Name in full)

(Please circle one area from the list below only)

Curtin Business School

·  Building 402 4 Reps

·  Building 407 2 Reps

·  Building 408 2 Reps

·  CGSB, 78 Murray St 2 Reps

·  Technology Park (602) 1 Reps

·  Technology Park (602 / 616) 2 Reps

·  Curtin Law School 1 Rep

Total SH Reps Required 14 Reps

Health Sciences

·  Biomedical Sciences (2) /Dental Therapy (1) 3 Reps

·  Clinics and B609 2 Rep

·  CHIRI – B305 8 Reps

·  Nursing, Midwifery and Paramedicine 2 Reps

·  Occupational Therapy & Social Work 2 Reps

·  Psychology & Speech Pathology 1 Rep

·  Pharmacy 4 Reps

·  Physiotherapy and Exercise Science 2 Rep

·  Public Health 2 Reps

·  PVC Office 1 Rep

·  Research & Graduate Studies 1 Rep

·  Curtin Medical School – (410) 1 Rep

Total SH Reps Required 29 Reps

Science & Engineering

·  Engineering (B314) 1 Reps

·  Engineering Pavilion 1 1 Rep

·  Engineering Pavilion 2 1 Rep

·  Engineering (B204) 2 Reps

·  Chemistry 6 Reps

·  Mechanical Engineering 1 Rep

·  Civil Engineering 1 Rep

·  Civil Engineering and Chemical Engineering (B601) 1 Rep

·  Electrical and Computing Engineering (Department) 1 Rep

·  Chemical Engineering 3 Rep

·  Petroleum Engineering (613 & 618/619) 2 Reps

·  Clean Gas Technology Australia (614) 1 Rep

·  Spatial Sciences / WASM 2 Reps

·  Physics and Astronomy 2 Reps

·  Medical Radiation Science (MRS) 1 Reps

·  Material Research Group (MRG) 1 Rep

·  Hydrogen Storage 1 Rep

·  Remote Sensing Research Group 1 Rep

·  SHRIMP Laboratory 1 Rep

·  Isotopes 1 Rep

·  Centre for Marine Science and Technology 1 Rep

·  Environment Agriculture 6 Reps

·  Geology 3 Reps

·  Geophysics 2 Reps

·  Computing, Maths & Stats 1 Rep

·  Curtin Institute of Radio Astronomy 1 Rep

·  Fuels and Energy Technology Institute 1 Rep

·  Corrosion Centre for Education, Research & Technology 1 Rep

·  Margaret River Campus 1 Rep

·  WASM Gold 1 Rep

·  WASM Metallurgy 3 Rep

·  WASM Administration and Museum 1 Rep

·  WASM (B703) 2 Reps

·  WASM - Graduate Hall, Student Guild, WMC Conference Centre (B704, 704A, 708) 1 Rep

Total SH Reps Required 56 Reps

Humanities

·  Built Environment (201)2 Reps

·  Department of Art & Design (202, 203 & 212)3 Reps

·  Department of Education (501) 2 Reps

·  MCCA & Part CECL (208) 2 Reps

·  MCCA Hayman Theatre (102) 1 Rep

·  Faculty Office (209) 1 Rep

Total SH Reps Required 11 Reps

Provost

·  Strategy & Planning/Business Support unit/ Quality Enhancement 1 Rep

Total SH Reps Required 1 Reps

DVC - Academic

·  Student Services 3 Reps

·  Curtin Stadium 1 Rep

·  Early Childhood Centre (Childcare) 1 Rep

·  Centre for Aboriginal Studies (211) 1 Rep

·  Housing Services (Kurrajong, Erica Underwood, Guild & Vickery) 4 Reps

·  WASM – Agricola 1 Rep

·  University Library (105) & JCPML (200A) 1 Rep

·  Curtin Teaching & Learning (105 & 603) 1 Rep

·  Kalgoorlie - Library 1 Rep

·  Ethics, Equity and Social Justice 1 Rep

·  Support Services – Counselling & Health Services 1 Rep

·  Support Services – START & Housing Services 1 Rep

·  Support Services – Careers & Campus Life 1 Rep

Total SH Reps Required 18 Reps

Properties, Facilities & Development (PFD)

·  Waste and Recycling 1 Rep

·  Properties, Facilities and Development –B110 1 Rep

·  Maintenance / Workshops 2 Reps

·  Public Realm 1 Rep

·  Asset Management, Security and Traffic 2 Reps

·  PFD – 109 1 Rep

Total SH Reps Required 8 Reps

Curtin International

·  Building 103 1 Rep

·  Building 102 1 rep

·  Building 100 1 Rep

·  Curtin College 2 Rep

Total SH Reps Required 5 Reps

Corporate Relations

·  MAPC ( Marketing Analytics, Platforms & Compliance) 1 Rep

·  Public Relations 1 Rep

·  John Curtin Gallery 1 Rep

·  Marketing 1 Rep

·  Curtin FM 1 Rep

·  Future Students 1 Rep

·  Office of Advancement, Ext Relations & VC’s Office 1 Rep

·  Curtin St Georges Terrace 1 Rep

Total SH Reps Required 8 Reps

Research and Development

·  Research and Development 2 Reps

·  Building 300 1 Rep

Total SH Reps Required 3 Reps

Corporate Services

·  Legal & Compliance / Records & Information Management 1 Rep

·  CITS 5 Reps

·  Human Resources 2 Reps

·  HR B310 Level 2 1 Reps

·  CITS (604) 1 Rep

·  Health & Safety /Injury Management (599) 1 Rep

·  Risk Management/ Secretariat / Council Secretary / Internal Audit/ ISU 1 Rep

·  Financial Services 1 Rep

Total SH Reps Required 13 Reps

Signed: ______Date: ______

Nominator

Accepted: ______Date: ______

Nominee

Acknowledged: ______Date: ______Head of Area
Procedure:

1) Have the nomination form completed in full.

2) The person nominating their colleague for SHR signs as nominator.

3) The nominee indicates accepting the nomination by signing.

4) The form should then be acknowledged by the Head of Area.

5) Forward completed forms to Health and Safety via Email

Office use only:

Form processed by / Date processed

Version 8.0 Uncontrolled document when printed Health and Safety

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