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Reportable Conduct Information Request Form
Reportable Conduct Information Request Form
Tasmania Police Reportable Conduct Information Request Form
PART A: PERSON / ENTITY REQUESTING INFORMATION: Entity
Name of Entity:
Name of the Head of the Entity or Delegate:
Address:
Contact Email:
Contact Phone:
Independent Investigator:
First Name:
Last Name:
Address:
Contact Email:
Contact Phone:
Name of Entity who has engaged the Independent investigator:
Entity Regulator:
First Name:
Last Name:
Address:
Contact Email:
Contact Phone:
Other:
First Name:
Last Name:
Address:
Contact Email:
Contact Phone:
PART B: LEGISLATION UNDER WHICH THE REQUEST IS BEING MADE
Please identify the Section of the Act being relied upon to request information or documents from Tasmania Police
Section 40
Other
If "other", please identify the Section of the Act being relied upon to request information or documents from Tasmania Police
PART C: WHAT IS BEING SOUGHT FROM TASMANIA POLICE
Please select:
Select between
1
and
3
choices.
Information
Documents
An update from Tasmania Police regarding the status of an investigation
PART D: REASON FOR REQUESTING INFORMATION
Section 40(3) of the Act enables the Commissioner of Police or a commissioned police officer to disclose information or documents in relation to the following matters, as referred to in Section 40(2): (b) a reportable allegation or reportable conviction (c) a concern or belief that reportable conduct has been committed (d) the investigation under Part 4 of these matters. Please provide a summary of why information and/or documents is being sought from Tasmania Police:
PART E: DETAILS OF THE REPORTABLE ALLEGATION OR CONVICTION
If information or documents are being sought from Tasmania Police in relation to a reportable allegation, a reportable conviction, or reportable conduct, please complete the following:
First Name (of person in relation to whom information is sought):
Last Name (of person in relation to whom information is sought):
Date of birth
DD slash MM slash YYYY
Address:
Workplace details:
Name of the Entity (workplace)
How is the person referred to above a worker?
Please select:
Employed by the Entity
Engaged by the Entity to provide services
Is elected to a role in respect of the Entity
Is engaged in training or work experience with the entity
Is carrying out work under the supervision of the Entity in accordance with a Court order
If the Entity is a religious body – a minister of religion, religious leader, a worker/officer of that body
Is a member, in respect of the Entity, of a class of persons prescribed under the Regulations.
Type of matter being investigated:
Please select:
A Reportable Allegation
A Reportable Conviction
Concern or belief that reportable conduct has been committed
Mandatory notification to the Regulator
Has the Regulator been notified of the reportable allegation or reportable conviction, in accordance with Section 34 of the Act?
Yes
No
What is the general nature of the Reportable Conduct
Annexure A (link to Annexure A: https://www.legislation.tas.gov.au/view/html/asmade/act-2023-006#GS7@EN) contains the list of matters which constitute reportable conduct under the Act. Please select:
Relevant offence committed against, with or in the presence of a child, whether or not criminal proceedings in relation to the offence have been commenced or concluded
Under the definition of Reportable Conduct, the second bullet point should read “sexual misconduct, that does not form part of a sexual offence, against, with or in the presence of a child
Physical violence against a child
Grooming of a child
Conduct that causes, or is likely to cause, significant emotional or psychological harm to a child
Significant neglect of a child
Conduct prescribed under the Regulations
Particulars of the Reportable Conduct:
Provide particulars of the offending which is said to constitute Reportable Conduct under the Act:
Offence name:
Legislation name:
Legislation section:
Offence name:
Legislation name:
Legislation section:
Offence name:
Legislation name:
Legislation section:
PART F: DOCUMENTS/INFORMATION REQUESTED
Please list the Documents or Information being requested from Tasmania Police
Add
Remove
PART G: RESTRICTIONS ON THE PROVISION OF INFORMATION / DOCUMENTS
Under Section 40(3)(d) of the Act, the Commissioner of Police or a commissioned police officer are authorised to disclose information or documents. Section 40(4) of the Act states that the disclosure of information or documents under Section 40(3) must relate to one or more of the following: (1) The purposes of the Act; (2) The promotion of the safety and wellbeing of children; (3) A prescribed purpose. Please specify how the provision of information / documents as identified above will satisfy one or more of these purposes:
PART H: ACKNOWLEDGMENT
I acknowledge that this request for information or documents is made under the Child & Youth Safe Organisations Act for the sole purpose identified above. I acknowledge that if I am provided with information in accordance with this request, I must not use or disclose such information other than (i) for the purpose for which the information was disclosed to me or (ii) in accordance with the Act, another Act or a law.
First Name:
Last Name:
Dated:
DD slash MM slash YYYY
