Information
PCBU's General Details
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ABN / ACN:
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PCBU - Registered Name:
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PCBU - Trading Name:
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Add location
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Main Type of Business
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Number of Workers:
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W/C Policy Number:
Consent Form
PCBU Representative
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Name:
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Phone Number:
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E-Mail:
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The personal information collected on this form will be used by SafeWork for the purpose of improving the way we interact with customers and the programs / projects we provide for specific industries.
It will be used to assist SafeWork NSW to establish and monitor work health and safety initiatives and to contact industry participants for follow up surveys and/or research. Access to and use of the personal information supplied will be restricted to SafeWork NSW employees, agents and contractors for the purposes listed above.
A third party may be engaged to conduct surveys or evaluation activities, on our behalf, in which case your contact details will be provided to them. In doing so they will be required to secure your information, use it only for the purpose for which it was collected and in compliance with the Privacy and Personal Information Protection Act 1998, and provide you with contact information should you wish to access or amend the personal information they hold or revoke your consent.
You have the right to access and amend the personal information we have collected or to revoke your consent at any time by contacting SafeWork NSW on 13 10 50 or writing to SafeWork NSW at Locked Bag 2906, Lisarow 2252 or privacy@safework.nsw.gov.au -
PCBU - Privacy consent statement:<br>I agree to provide the personal information contained in this form. I have been provided with a copy of the Privacy / Consent Statement and I understand the terms of the statement which includes my consent to SafeWork NSW to contact me in the future as described in the Privacy / Consent Statement
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Name:
