- Change of Responsible Officer Details (PDF 196 KB)
- Change of Responsible Officer Details (Word 197 KB)
Release Date: July 2019
Facilities must report changes to Responsible Officer(s) details to the Department of Health (Health) as soon as possible and within two business days of the change occurring.
Providing information to Health
The information you provide to Health is mandated by the National Health Security Act 2007 and will be included on the National Register.
It is important to answer all questions and to provide accurate information. If the information you provide is incorrect or incomplete, Health may require you to provide additional information. This may cause delays.
Personal information provided to Health will comply with the requirements of the Privacy Act 1988.
Please ensure that the person completing this form holds the appropriate authority to submit this application on behalf of the entity or facility.
Instructions on completing this form
This document allows electronic entry of information into the required fields. It is recommended that, where possible, this form should be completed on a computer and a copy printed, signed and sent to Health.
All questions are mandatory and must be completed. If the space provided in each field is not sufficient to complete your answer, please include any additional information in an attachment with the information clearly marked as to which question it relates to.
Please ensure you retain a copy of this completed form as Health is unable to provide copies of submitted documents.
To lodge this form via post you will need to use an opaque envelope and post using Australia Post’s Registered Mail service. You are considered to have submitted the report at the date and time shown on the registered post receipt.
Please do not email or fax forms to Health as these cannot be accepted.
Please submit all postal applications to:
Health Emergency Planning, Security and Laboratories Section
Department of Health
MDP 140, GPO Box 9848
Canberra ACT 2601
Once Health has received the form, you will be provided with a confirmation of receipt by email to the contact officer listed for the facility.
Please use your facility reference number to refer to any matters relating to your facility.
If you have any queries about this form please contact the SSBA Regulatory Scheme:
Telephone: (02) 6289 7477
(This page contains form/s that are intended to be paper based that you can download and complete. If you are using any assistive technology and are unable to use the form please contact us using the Online form and feedback).