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 (608 / 616) 2 Reps
Total SH Reps Required 13 Reps
Health Sciences
· Biomedical Sciences (2) /Dental Therapy (1) 3 Reps
· CHIRI – Clinics and B609 2 Rep
· CHIRI – B305 8 Reps
· Nursing & Midwifery 2 Reps
· Occupational Therapy & Social Work 2 Reps
· Psychology & Speech Pathology 1 Rep
· Pharmacy 3 Reps
· Physiotherapy and Exercise Science 2 Rep
· Public Health 1 Rep
· PVC Office 1 Rep
· Research & Graduate Studies 1 Rep
· Shenton Park 1 Rep
Total SH Reps Required 27 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
· Electrical Engineering & Computing 1 Rep
· Chemical Engineering 3 Rep
· Petroleum Engineering 1 Rep
· Clean Gas Technology Australia (614) 1 Rep
· Spatial Sciences / WASM 2 Reps
· Imaging & Applied Physics 2 Reps
· Medical Imaging 2 Reps
· Material Research Group (MRG) 1 Rep
· Hydrogen Storage 1 Rep
· Trace Facility 1 Rep
· Remote Sensing Research Group 1 Rep
· SHRIMP Laboratory 1 Rep
· Isotopes 1 Rep
· Centre for Marine Science and Technology 1 Rep
· Agriculture & Environment 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 1 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 54 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
· SSAL & part MCCA & HPVCO (209)1 Rep
Total SH Reps Required 11 Reps
DVC - Academic
· Strategy & Planning 1 Rep
· Business Support unit 1 Rep
· Quality Enhancement 1 Rep
Total SH Reps Required 3 Reps
VC - Education
· Student Central 2 Reps
· Curtin Stadium 1 Rep
· Early Childhood Centre (Childcare) 1 Rep
· Centre for Aboriginal Studies (211) 1 Rep
· Support Services (Health Service, Counselling, University Life) 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 Reps
· 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
· Properties Facilities and Development 1 Rep
· Campus Services (Janitors, Stores) 2 Rep
· Maintenance / Workshops 4 Reps
· Public Realm 1 Rep
· Transport, Parking and Security 2 Reps
Total SH Reps Required 10 Reps
Curtin International
· Building 103 1 Rep
· Building 102 1 rep
· Building 100 1 Rep
· Curtin College 1 Rep
Total SH Reps Required 4 Reps
Corporate Relations & Development
· 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
· PSCU 1 Rep
Total SH Reps Required 8 Reps
Research and Development
· Research and Development 1 Rep
· Centre for Fuels & Energy 1 Rep
· Building 300 1 Rep
Total SH Reps Required 3 Reps
Corporate Services
· Secretariat / Council Secretary / Internal Audit 1 Rep
· Legal & Compliance / Records & Information Management 1 Rep
· CITS 5 Reps
· Human Resources 2 Reps
· ODU (604) 1 Rep
· Health & Safety /Injury Management (599) 1 Rep
· Risk Management 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 processedVersion 5.0 Uncontrolled document when printed Health and Safety
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