[name of the responsible person within the meaning of clause 44(2) of Schedule 3 to theOffshore Petroleum and Greenhouse Gas Storage Act 2010]
I, [name of the health and safety representative issuing the notice], elected as the health and safety representative in accordance with Schedule 3 to the Offshore Petroleum and Greenhouse Gas Storage Act 2010 for [description of the designated work group], after consultation in accordance with clause 44(1) of Schedule 3 to that Act, believe that the following *provision/*provisions of *the Offshore Petroleum and Greenhouse Gas Storage Act 2010/*the Offshore Petroleum and Greenhouse Gas Regulations 2021/*the Offshore Petroleum and Greenhouse Gas Storage Act 2010 and the Offshore Petroleum and Greenhouse Gas Regulations 2021 *is/*are being contravened or *is/*are likely to continue to be contravened:
The contravention is [a brief description]
The contravention is occurring at [location]
The reasons for my opinion are as follows:
In accordance with clause 44(5)(b) of Schedule 3 to the Offshore Petroleum and Greenhouse Gas Storage Act 2010, action necessary to prevent the contravention, or the likely contravention, of the provision or provisions referred to above must be taken before [the date of a day that is:
(a) not less than 7 days after the day when the notice is issued; and
(b) reasonable in the opinion of the health and safety representative].
In accordance with clause 44(6) of Schedule 3 to the Offshore Petroleum and Greenhouse Gas Storage Act 2010, I specify the following action to be taken: .
[signature]
Health and safety representative
Under clause 45(1) of Schedule 3 to the Offshore Petroleum and Greenhouse Gas Storage Act 2010 ("the Act"), a person to whom a provisional improvement notice is given may, within 7 days, request NOPSEMA or a NOPSEMA inspector to conduct an investigation into the subject matter of the notice.
Clause 45(5) of Schedule 3 to the Act requires a responsible person to whom a provisional improvement notice is given—
to notify each designated work group member affected by the notice of the fact that the notice has been issued; and
Schedule Sch 2 - Offshore Petroleum and Greenhouse Gas Storage Regulations 2021 - Forms | Zoe
to display a copy of the notice at or near each workplace at which work that is the subject of the notice is being performed.
Under clause 45(6) of Schedule 3 to the Act, a provisional improvement notice ceases to have effect if—
it is cancelled by the health and safety representative or a NOPSEMA inspector; or
the responsible person takes the action specified in the notice, or if no action is specified, takes the action that is necessary to prevent the further contravention, or likely contravention, with which the notice is concerned.
Clause 45(7) of Schedule 3 to the Act requires the responsible person—
to ensure, to the extent that the provisional improvement notice relates to any matter over which the person has control, that a provisional improvement notice is complied with; and
to take reasonable steps to inform the health and safety representative who issued the notice of the action taken to comply with the notice.
Under clause 95 of Schedule 3 to the Act, if a NOPSEMA inspector has confirmed or varied a provisional improvement notice, any of the following persons may request Fair Work Australia in writing to review the NOPSEMA inspector's decision to confirm or vary the notice—
the person to whom the notice was 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 any workplace, plant, substance or thing to which that decision relates.
Form 2
Regulations 44 and 124(b)
Notice of *Removal/*Sampling of Plant, Substance or Thing
To: [*name of *operator of facility/*employer of members of the workforce at the facility/owner of the plant, substance or thing]
and [name of health and safety representative for designated workgroup]
I, [name of NOPSEMA inspector], a NOPSEMA inspector appointed under section 602 of the Offshore Petroleum and Greenhouse Gas Storage Act 2006 of the Commonwealth, in the course of conducting an inspection under clause 55 of Schedule 3 to the Offshore Petroleum and Greenhouse Gas Storage Act 2010, have taken *possession/*a sample of:
[description of plant, substance or thing removed or sampled]
from the workplace at:
[address]
The reason for this action is:
[explanation of why removal or sampling was necessary]
Under clause 93 of Schedule 3 to the Offshore Petroleum and Greenhouse Gas Storage Act2010 ("the Act"), a person who tampers with, or removes, this notice, before the item to which this notice relates has been returned to the workplace, may be liable to a penalty of 60 penalty units.
Under clause 82(3) of Schedule 3 to the Act, if this notice has been issued to the operator of the facility from which the item was removed, the operator's representative at the facility must cause a copy of the notice to be displayed in a prominent place at the workplace from which the item was removed.
Under clause 95 of Schedule 3 to the Act, any of the following persons may request Fair Work Australia in writing to review the NOPSEMA inspector's decision to take possession of the item to which this notice relates—
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;
Form 3
Regulations 44 and 124(c)
Do Not Disturb Notice
To: [name of operator's representative at the facility]
I, [name of NOPSEMA inspector] a NOPSEMA inspector appointed under section 602 of the Offshore Petroleum and Greenhouse Gas Storage Act 2006 of the Commonwealth, direct that [name of operator] must ensure that:
[*description of the affected *workplace or part of workplace/*plant/*substance/thing]
is not disturbed during the period from [time] on [date]
to [time] on [date].
The reasons for giving this direction are:
Under clause 83(6) of Schedule 3 to the Offshore Petroleum and Greenhouse Gas Storage Act 2010 ("the Act"), an operator of a facility who does not ensure that this notice is complied with may be liable to a penalty of 120 penalty units.
Under clause 83(4) of Schedule 3 to the Act, this notice must be displayed in a prominent place at the workplace or where the relevant plant, substance or thing is located.
Under clause 93 of Schedule 3 to the Act, a person who tampers with or removes this notice before it ceases to have effect may be liable to a penalty of 60 penalty units.
Under clause 95 of Schedule 3 to the Act, any of the following persons may request Fair Work Australia in writing to review the NOPSEMA inspector's decision to direct that a workplace, a part of a workplace, plant, a substance or thing not be disturbed—
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;
Form 4
Regulations 44 and 124(d)
Prohibition Notice
To: [name of operator's representative at the facility]
I, [name of NOPSEMA inspector], a NOPSEMA inspector appointed under section 602 of the Offshore Petroleum and Greenhouse Gas Storage Act 2006 of the Commonwealth, am satisfied that it is reasonably necessary to issue a prohibition notice to the operator of [name of the facility] in order to remove an immediate threat to the health or safety of a person.
I am of the opinion that the following activity is a threat to the health or safety of a person:
[specify activity]
I THEREFORE DIRECT that the operator ensure that:
*the activity is not engaged in.
*the activity is not engaged in in the following manner: [specify the manner in which it is not to be engaged. If insufficient space, use additional page]
The reasons why I am satisfied that the activity has caused the threat to health or safety are:
[specify reasons. If insufficient space, use additional page]
*Action that may be taken that will be adequate to remove the threat to health or safety is:
[specify action. If insufficient space, use additional page]
Under clause 87 of Schedule 3 to the Offshore Petroleum and Greenhouse Gas Storage Act 2010 ("the Act"), an operator who fails to ensure that this notice is complied with may be liable to a penalty of 240 penalty units.
Under clause 88(1) of Schedule 3 to the Act, a notice ceases to have effect when a NOPSEMA inspector notifies the operator that the NOPSEMA inspector is satisfied that the operator has taken adequate action to remove the threat to health or safety.
Under clause 86(2) of Schedule 3 to the Act, this notice must be displayed in a prominent place at or near each workplace at which work that is affected by the notice is performed.
Under clause 93 of Schedule 3 to the Act, a person who tampers with or removes this notice before it ceases to have effect may be liable to a penalty of 60 penalty units.
Under clause 95 of Schedule 3 to the Act, any of the following persons may request Fair Work Australia in writing to review the NOPSEMA inspector's decision to issue a prohibition notice—
the operator of the facility or any employer who is affected by the decision;
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.
Form 5
Regulations 44 and 124(e)
Improvement Notice
[reference number]
To: [name of responsible person]
I, [name of NOPSEMA inspector], a NOPSEMA inspector appointed under section 602 of the Offshore Petroleum and Greenhouse Gas Storage Act 2006 of the Commonwealth, am satisfied that the person named above as the responsible person is contravening, or has contravened, and is likely to contravene again:
(a) clause [specify clause] of Schedule 3 to the Offshore Petroleum and Greenhouse Gas Storage Act 2010; or
(b) regulation [specify] of the Offshore Petroleum and Greenhouse Gas Storage Regulations 2021; or
(c) section *654/*663 of the Offshore Petroleum and Greenhouse Gas Storage Act 2010;
at
[location of workplace].
The reasons for my opinion are:
[brief description of contravention and reasons]
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/*regulation/*section.
*The following action must be taken by the responsible person within the period specified above:
[specify action. If insufficient space, use additional page]
You are directed to sign and return the declaration at the bottom of this Improvement Notice once the required improvement has been completed.
When the required improvement has been completed, return this part of the notice to the following person at the address below:
Name: [insert name of person to whom declaration is to be delivered]
Position: [position of person to whom declaration is to be delivered]
Address: [address of person to whom declaration is to be delivered]
Telephone number: [telephone number of person to whom declaration is to be delivered]
Improvement Notice [insert reference number] has been complied with.
Signed: [signature of responsible person]
This declaration was delivered to: [insert name of person to whom declaration was delivered]
in the office or position of: [insert office or positionof person to whom declaration was delivered]
at: [insert time] on [insert date].
NOTES
Under clause 92 of Schedule 3 to the Offshore Petroleum and Greenhouse Gas Storage Act 2010 ("the Act"), a responsible 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 120 penalty units.
If this notice is displayed at a workplace by the operator's representative in accordance with clause 91(2) of Schedule 3 to the Act, clause 93 of that Schedule provides that the notice must not be tampered with or removed before it has ceased to have effect.
Under clause 91(2) of Schedule 3 to the Act, if this notice was issued to an operator or an employer of a member of the workforce, the operator's representative at the facility 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.
Under clause 95 of Schedule 3 to the Act, any of the following persons may request Fair Work Australia to review the NOPSEMA inspector's decision to issue an improvement notice—
the operator of the facility or any employer who is affected by the decision;
the person to whom the 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;