To: SafeWork NSW, internal review
From: [Business name] [Contact name, phone and email]
Application for internal review of improvement notice [notice number]
| Notice type | Improvement notice |
|---|---|
| Notice number | [Notice number] |
| Issued by | [Inspector name] |
| Received | [Date received] |
| Compliance date | [Compliance date] |
We are an eligible person for this decision and apply for internal review under s 224 of the Work Health and Safety Act 2011 (NSW).
Reasons we ask for the decision to be reviewed:
- [Set out each reason, with the facts and any evidence you rely on]
Outcome we ask for: [e.g. that the notice be cancelled, varied, or its compliance date extended]
We note that this application stays the operation of the improvement notice (s 228).
Attached: a copy of the notice and the documents supporting these reasons.
[Name]
[Business name]
Date: ____________