Schedule 2

Forms

Current

[r. 27AA and 27AB]

[Heading inserted: SL 2023/194 r. 32.]

Form 1 — Notice from Commissioner of Police under s. 41

		Notice from Commissioner of Police about prosecution of registered teacher Section 41 Teacher Registration Act 2012			Teacher Registration Board of Western Australia

To	Teacher Registration Board of Western Australia
	By post Teacher Registration Board of WA Investigations & Compliance Branch P.O. Box 3019 EAST PERTH WA 6892			By email icb@trb.education.wa.edu.au
From	Commissioner of Police
Details of accused/offender
Full name				D.O.B.
Residential address
Employer
Details of notification
Circumstance that has occurred	□ A registered teacher was charged with an actionable offence. □ A registered teacher was convicted or found guilty of an indictable offence dealt with summarily. □ Charges were discontinued or there was a mistrial or acquittal in relation to an actionable offence.
	*actionable offence* is defined in the Teacher Registration Act 2012 section 3 to mean — (a) an offence that, on conviction, would result in the person charged being a child sex offender; or (b) a sexual offence committed against or in respect of a child; or (c) a sexual offence committed when a child was present, or within sight of a child; or (d) an offence the commission of which used or involved material the production of which involved a sexual offence against or in respect of a child; or (e) an offence prescribed for the purposes of this definition.
Details of charges / convictions
Date of alleged conduct	Include range of dates (if applicable)
Incident report no.
Charges / convictions Include Act and section
Court
Convicted / found guilty Date Sentence	Provide the sentence for each charge and the aggregate sentence (if applicable)
Particulars of offence/s
Insert here or attach the Statement of Material Facts (if available)
The matter has been reported to the Working with Children Screening Unit □ Yes □ No
Full name of notifier
Position/rank
Station/squad/location
Contact number			Email
Date

Form 2 — Notice from Commissioner of Police under s. 41A

			Notice from Commissioner of Police of identifying information Section 41A Teacher Registration Act 2012					Teacher Registration Board of Western Australia

To		Teacher Registration Board of Western Australia
		By post Teacher Registration Board of WA Investigations & Compliance Branch P.O. Box 3019 EAST PERTH WA 6892					By email icb@trb.education.wa.edu.au
From		Commissioner of Police
Details of registered teacher the subject of prosecution
Full name:
Date of birth:

Identifying information
Name	Date of birth			Address		Phone no.			Email








Full name of notifier
Position/rank
Station/squad/location
Contact number					Email
Date

Form 3 — Notice from Director of Public Prosecutions under s. 41B

		Notice from Director of Public Prosecutions Section 41B Teacher Registration Act 2012			Teacher Registration Board of Western Australia
Information below is subject to the Evidence Act 1996 section 36C and is not for publication.

To	Teacher Registration Board of Western Australia
	By post Teacher Registration Board of WA Investigations & Compliance Branch PO Box 3019 EAST PERTH WA 6892			By email icb@trb.education.wa.edu.au
From	Director of Public Prosecutions			ODPP reference
Details of accused/offender
Full name				D.O.B.
Residential address
Details of notification
Circumstance that has occurred	□ A registered teacher was convicted or found guilty of an indictable offence. □ All charges of actionable offences against a registered teacher were discontinued. □ A registered teacher was acquitted, or there was a mistrial, in relation to an actionable offence.
	*actionable offence* is defined in the Teacher Registration Act 2012 section 3 to mean — (a) an offence that, on conviction, would result in the person charged being a child sex offender; or (b) a sexual offence committed against or in respect of a child; or (c) a sexual offence committed when a child was present, or within sight of a child; or (d) an offence the commission of which used or involved material the production of which involved a sexual offence against or in respect of a child; or (e) an offence prescribed for the purposes of [the] definition.
Details of charges/convictions
Date of alleged conduct	Include range of dates (if applicable)
Police brief no.
Charges / convictions Include Act and section
Court
Date of finding
Details of sentence	Provide the sentence for each charge and the aggregate sentence (if applicable). Continue over page if required.
Further information if required


Full name of notifier
Position
Office/Location
Contact number			Email
Date

[Schedule 2 inserted: SL 2023/194 r. 32; amended: SL 2024/188 r. 5.]

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