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Environmental Officer Appointment form

Please complete this form if you would like to nominate for an environmental position in your zone.
Form fields marked with an asterisk (*) are mandatory
First name:
Surname:
Email address: *
Department/School/Unit:
Faculty/Division:
Campus:
Phone number:

OHS zone to which you belong:
List of OHSE zones
I would like to nominate myself as the following: Environmental Officer
Specify areas (ie departments/divisions) which you will be covering:

Approval by my Head of Department/Unit/Supervisor:
Authorised by (Name): *
Authoriser's telephone:
Declaration (please tick): *

My supervisor has approved the above nomination