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Ballot papersSchedule 3.2 Ballot paper under Part 3 of Chapter 3Form 1

Schedule 3.2—Ballot papers

(regulation 3.16)

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

1omit if inapplicable

2. The employees who are to be balloted are [description].

Fair Work Regulations 2009

127

Compilation No. 36

Compilation date: 11/09/2021

Registered: 19/10/2021

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