Department of Justice
WorkSafe Tasmania
PO Box 56, Rosny Park,TAS 7018
Phone in Tasmania:1300 366 322
Phone outside Tasmania: 03 6166 4600
Email: wstinfo@justice.tas.gov.au
Website www.worksafe.tas.gov.au

Request form for the Regulator to commence a prosecution

Information Request under section 231 of the work health and safety act for the regulator to commence a prosecution
for a section 31 (category 1)) or section 32 (category 2) offence of the Work Health and Safety Act
Information: All fields are mandatory unless marked as optional.

Applicant’s details (mandatory)

Full name (first name and last name)

Contact telephone number

Email address (if available)

Postal address

What is your relationship with the workplace to which your issue relates?

Nature of the work health and safety issue (mandatory)

How do you believe the person has contravened the Work Health and Safety Act (Please provide information that details the act, matter or thing that you believe relates to the contravention)

Date the alleged offence is believed to have occurred (dd/mm/yyyy)

Address where the alleged offence occurred

Details of the person conducting the business or undertaking you believe has committed the offence (if known)

Name of business

Business address (write “as above” if same as the address where the alleged offence occurred)

ABN/ACN

Telephone contact number

Email address

Names, positions (including the name of the organisation they represent), and contact details of people who may have information relevant to the alleged offence

Note

1. The Regulator will maintain confidentiality over your personal details to the extent permissible and required by law.
2. It may be necessary for the Regulator to formally take a statement from you arising from your request.
3. You are advised that it is a requirement of the WHS Act that as a result of your request to the Regulator to commence a prosecution, the person you believe committed the offence will be informed by the Regulator of the request and of the Regulators decision.

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Request form for the Regulator to commence a prosecution

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