I, [insert name of employer or employer’s representative applying to Magistrate for issue of covert surveillance authority], apply under the Workplace Surveillance Act 2005, section 23, for the issue of a covert surveillance authority authorising the carrying out of covert surveillance of employees while at work for the employer.
Dated
[signature]
[name of applicant]
Note—
Under the Workplace Surveillance Act 2005, section 23(5), the Magistrate to whom an application for issue of a covert surveillance authority is made must not issue the authority unless the information given by the applicant in or in connection with the application is verified before the Magistrate on oath or affirmation or by affidavit. Under the Act, section 23(7), the Magistrate may require the applicant to provide (either orally or in writing) any further information the Magistrate requires about the grounds on which the authority is being sought.
* Delete whichever is inapplicable.
Form 2
Section 4(2)
Form of covert surveillance authority
I, [insert name of Magistrate or judicial member of the Industrial Relations Commission issuing covert surveillance authority], under the Workplace Surveillance Act 2005, Part 4, Division 2, issue a covert surveillance authority authorising the carrying out of covert surveillance of employees while at work for the employer.
Dated
[signature]
[name of Magistrate or judicial member of the Industrial Relations Commission]
I, [insert name of the employee, employer or other person affected by the covert surveillance authority applying to a Magistrate for variation of the authority], apply under the , section 31, for the variation of the covert surveillance authority issued to [] on [] by [] authorising the carrying out of covert surveillance of employees while at work for the employer during the period from [] on [] to [] on [].
I, [insert name of the employee, employer or other person affected by the covert surveillance authority applying to a Magistrate for cancellation of the authority], apply under the Workplace Surveillance Act 2005, section 31, for the cancellation of the covert surveillance authority issued to [insert name of employer or employer’s representative to whom authority was issued] on [insert date on which authority was issued] by [insert name of person who issued the authority sought to be cancelled] authorising the carrying out of covert surveillance of employees while at work for the employer during the period from [time] on [date] to [time] on [date].
The following are the grounds on which cancellation of the authority is sought—
[state the grounds on which applicant seeks cancellation]
Dated
[signature]
[name of applicant]
Form 5
Section 4(5)
Form of report on use of authority
I, [insert name of the employer or employer’s representative], give this report under the Workplace Surveillance Act 2005, section 35(1), confirming that covert surveillance was carried out in accordance with a covert surveillance authority during the period from [time] on [date] to [time] on [date].
Dated
[signature]
[name of employer or employer’s representative]
I, [insert name of employer or employer’s representative aggrieved by Magistrate’s decision to refuse to issue the covert surveillance authority], apply under the Workplace Surveillance Act 2005, section 41, for the issue of a covert surveillance authority authorising the carrying out of covert surveillance of employees while at work.
Dated
[signature]
[name of applicant]
Note—
The Workplace Surveillance Act 2005, section 41(4), applies Part 4 of the Act to the issue, variation or cancellation of a covert surveillance authority by a judicial member of the Industrial Relations Commission under section 41 of the Act in the same way as it applies to the issue, variation or cancellation by a Magistrate under that Part. Under the Act, section 23(5), the Magistrate to whom an application for issue of a covert surveillance authority is made cannot issue the authority unless the information given by the applicant in or in connection with the application is verified before the Magistrate on oath or affirmation or by affidavit. Under the Act, section 23(7), the Magistrate to whom the application is made may require the applicant to provide, either orally or in writing, such further information as the Magistrate requires concerning the grounds on which the authority is being sought.
I, [insert name of the employee, employer or other person affected by the covert surveillance authority applying to a judicial member of the Industrial Relations Commission for variation of the authority], apply under the Workplace Surveillance Act 2005, section 41, for the variation of the covert surveillance authority issued to [insert name of employer or employer’s representative to whom authority was issued] on [insert date on which authority was issued] by [insert name of person who issued the authority sought to be varied] authorising the carrying out of covert surveillance of employees while at work for the employer during the period from [time] on [date] to [time] on [date].
The following are the variations sought to the covert surveillance authority described above—
[describe variations sought by applicant]
The following are the grounds on which variation of the authority is sought—
[state the grounds on which applicant seeks variation]
I, [insert name of the employee, employer or other person affected by the covert surveillance authority applying to a judicial member of the Industrial Relations Commission for cancellation of the authority], apply under the Workplace Surveillance Act 2005, section 41, for the cancellation of the covert surveillance authority issued to [insert name of employer or employer’s representative to whom authority was issued] on [insert date on which authority was issued] by [insert name of person who issued the authority sought to be cancelled] authorising the carrying out of covert surveillance of employees while at work for the employer during the period from [time] on [date] to [time] on [date].
The following are the grounds on which cancellation of the authority is sought—
[state the grounds on which applicant seeks cancellation]