Ballot paper under Part 3 of Chapter 3
Form 1 Ballot paper under Part 3 of Chapter 3
(regulation 3.16)
Fair Work Act 2009, Chapter 3, Part 3.3, Division 8
BALLOT OF MEMBERS OF (Name of organisation) BALLOT PAPER IN RESPECT OF PROTECTED ACTION BALLOT CLOSING DATE OF BALLOT: (Date) | (Initials, or facsimile of initials, of the person conducting the ballot) |
The proposed protected industrial action to which this ballot applies is [description].
DIRECTIONS TO VOTERS
1. Record your vote on the ballot paper as follows:
• if you approve the proposed protected industrial action, mark the YES box opposite the question;
• if you do not approve the proposed protected industrial action, mark the NO box opposite the question.
2. Do not place on this paper any mark or writing that may identify you.
QUESTION(S) FOR VOTERS
(Text of question or questions as ordered by Fair Work Commission) | YES | |
NO |
INFORMATION FOR VOTERS
1. The applicant(s) for the protected action ballot order is or are [name(s)]. 1
1. The agent of the applicant(s) for the protected action ballot order is [name]. 1
1 omit if inapplicable
2. The employees who are to be balloted are [description].
3. The protected action ballot agent authorised to conduct the ballot is [name].
YOUR VOTE IS SECRET, AND YOU ARE FREE
TO CHOOSE WHETHER OR NOT TO SUPPORT
THE PROPOSED INDUSTRIAL ACTION.
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