Document ID: chunk:federal_register_of_legislation:F2024C00347:reg:6:p20
Version: federal_register_of_legislation:F2024C00347
Segment Type: reg
Provision Reference: reg 6 (pt 20/21)
Character Range: 145110–147796

and is likely to contravene:
 (a) clause        of Schedule 3 to the Act; or
 (b) regulation        ;
at
(location of workplace).
The reasons for my opinion are:
(brief description of contravention)
You are required to take action within (insert number) days of the date of this notice to prevent any further contravention or likely contravention of the clause or regulation.
*The following action must be taken by the responsible person within the period specified above:
(If insufficient space, use additional page)
Signed: (OHS Inspector)
Dated:
*(Omit if inapplicable)

(Page 2 of Form 5)
When the required improvement has been completed, return this part of the notice to the following person at the address below:
Name:
Position:
Address:
Telephone number:
Improvement Notice No.     has been complied with.
Signed:
‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑
This notice was delivered to: (insert name)
in the office or position of (insert office or position)
at: (insert time, am or pm) on (insert date).
(See notes on page 3)

(Page 3 of Form 5)

NOTES
1.   Under clause 78 of Schedule 3 to the Act, a person who fails to ensure that this notice is complied with, to the extent that it relates to a matter over which the person has control, may be liable to a penalty of 100 penalty units.
2.   This notice must be displayed in a prominent place at the workplace and, under clause 79 of Schedule 3 to the Act, must not be tampered with or removed before the notice has ceased to have effect.
3.   Under subclause 78(11) of Schedule 3 to the Act, an operator, or an employer of a member of the workforce to whom this notice is given must:
    (a) give a copy of the notice to each health and safety representative for a designated workgroup having group members performing work that is affected by the notice; and
    (b) display a copy of the notice in a prominent place at or near each workplace at which the work is being performed.
4.   Under clause 81 of Schedule 3 to the Act, any of the following persons may request Fair Work Australia to review the OHS inspector's decision:
   the operator of the facility or an employer who is affected by the decision;
   any person to whom an improvement notice has been issued;
   the health and safety representative for a designated work group that includes a group member affected by the decision;
   a workforce representative in relation to the designated work group that includes a group member affected by the decision;
   if there is no designated work group — a workforce representative in relation to a member of the workforce affected by the decision;
   the owner of