Schedule 3.3Forms relating to entry to premises Form4Affected member certificate
Fair Work Regulations 2009, regulation 3.29
AFFECTED MEMBER CERTIFICATE
This certificate is issued to [name of organisation].
Section 520 of the Fair Work Act 2009 authorises Fair Work Commission to issue an affected member certificate if a permit holder seeks to enter premises for the purpose of investigating contraventions, or suspected contraventions, of the Fair Work Act 2009, or a term of a fair work instrument.
For section 520 of the Fair Work Act 2009, Fair Work Commission is satisfied that:
* a member of the organisation performs work on the premises below; and
* the organisation is entitled to represent the industrial interests of the member; and
* a suspected contravention of the Fair Work Act 2009, or a term of a fair work instrument, relates to, or affects, that member.
For this certificate:
(a) The premises to which it relates are:
[name and address of premises]
(b) The suspected contravention or contraventions to which it relates are:
[particulars of suspected contravention or contraventions]
Delegate of Fair Work Commission
Fair Work Regulations 2009
Compilation No. 36
Compilation date: 11/09/2021