Research Innovation and Commercialisation / Research Ethics and Integrity / AA FPP Test

The University of Melbourne

Biosecurity ‘Fit and Proper Person Test’ Checklist and Declaration

The Biosecurity Act 2015 (Cth) (Biosecurity Act) provides a regulatory framework for the management of biosecurity risks to support Australia’s biosecurity system. This system is important in helping prevent the entry and establishment of exotic pests and diseases likely to harm Australia's agricultural systems, natural environment, community health and economy.

The University of Melbourne (University)imports materials and conducts research that is regulated underthe Biosecurity Act in order to manage anybiosecurity risk to Australia. This means theUniversity must have appropriate permits, licences, and arrangementsapproved by the Department of Agriculture and Water Resources and ensure thatany requirements specified for these are met.Under section 530 of the Biosecurity Act, the University must declare whether it or any of its ‘associates’ are ‘fit and proper persons’ when applying for a biosecurity approval. Associates caninclude persons performing biosecurity activities (e.g. handling imported materials) or thosewho are in a position to control or influence the operation of a biosecurity arrangement (such as a biosecurity containment facility).

Please complete this Checklist and Declaration to the best of your knowledge. This will be kept securely as a Biosecurity Record to satisfy verification audits by The Department of Agriculture and Water Resources.

Please note that you may be liable to a civil penalty under the Biosecurity Act for giving false or misleading information.

Name:______

Fit and Proper PersonChecklist

Please answerthe following questions in relation to the Acts listed. Provide further details for any question answered ‘Yes’ and attach these to this form.

  • Biosecurity Act 2015(Cth)
  • Quarantine Act 1908(Cth)
  • Customs Act 1901(Cth)

  1. Have you been convicted of an offence against* or ordered to pay a pecuniary penalty under any of the above Acts?
Include convictions or fines ordered under the Criminal Code or the Crimes Act 1914 to the extent that it relates to any of the above Acts.
*Note: Do not include any convictions older than 10 years if you:
• were not sentenced to imprisonment, or
• were sentenced to imprisonment of no more than 30 months / □ Yes
□ No
If YES, please provide further details
  1. Do you have anydebts dueand payable to the Commonwealth under any of the above Acts?
/ □ Yes
□ No
If YES, are any of the debts more than 28 days overdue? Please provide further details. / □ Yes
□ No
□ N/A
  1. Have you had a permit, approval, arrangement or licence refused under any of the above Acts?
/ □ Yes
□ No
If YES, were any of these refusals in part or full due to a record of non-compliance? Please provide further details. / □ Yes
□ No
□ N/A
  1. Have you had a permit, compliance agreement, approval, arrangement or licence suspended, revoked or cancelled in part or in full under any of the above Acts?
Note: Do not include any decision to suspend, revoke or cancel that was set aside on review / □ Yes
□ No
If YES, were any of these due to failure or refusal to comply with the relevant requirements of the arrangement, permit and/or licence? Please provide further details. / □ Yes
□ No
□ N/A
  1. Are there any other matters relevant to whether you are a fit and proper person that you would like noted?


/ □ Yes
□ No
Declaration:
By signing the below, I declare that:
  • the information I have provided in the above checklist is true and correct; and
  • I will inform The University of Melbourne if any of this information changes for any reason.

Signature / Date

Personal Information Collection Notice Statement

The information on this form is being collected byThe University of Melbourne. You can access any personal information the University holds about you.The University’s Privacy Officer can be contacted at .

The information is being collected for the purposes described above and in order to satisfy the University’s obligations under the Biosecurity Act 2015 (Cth).

The information will be used by authorised staff for the purpose for which it was collected and will be protected against unauthorised access and use.

Please note that failure to provide the information required to complete this form, may affect your ability to lawfully carry out biosecurity activities at The University of Melbourne.

Reviewed by / Date

(Name and signature)

Version 3.0 April, 2017