Title Page
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Date of Survey
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Site
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Officer Name
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Officer Employee Number
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Photo of SIA Licence (& Systematic ID)
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Who do you work for?
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What is your Pay Rate?
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How do you get paid?
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What is your pay frequency?
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Do you have any outstanding issues with your pay?
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Please give details
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Do you have any outstanding issues/queries?
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Please give details
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Officer Name
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Surveyor Name