What it contains

This document provides HSRs with a blank PIN form to capture information about occupational health and safety laws being contravened by an individual employer or HSR. Topics to be completed in the form include:

• the name of the HSR completing the form
• who will receive the PIN
• check box that the HSR has consulted the person receiving the PIN before it is issued
• how the PIN will be issued
• details of how OHS laws that have been contravened
• how the HSR believes the contravention can be fixed

Important: Please download this PDF to your computer. You can fill it in using Adobe Reader but it will not save if you attempt to fill it in using your web browser.