COURSE TITLE                   ____________________________________________

DATE(S) OF COURSE           ____________________________________________

                                      ____________________________________________

VENUE                              ____________________________________________

REPRESENTATIVES NAME     ____________________________________________

EMPLOYER                         ____________________________________________

*It is/it is not (*please delete) our intention to grant paid release from work for the above representative to attend the above course.

Signed on behalf of the Employer   ______________________________________

Please print name                        ______________________________________

Daytime telephone number            ______________________________________

Date                                          ______________________________________

Your attention is drawn to the legal rights that Trade Union Representatives have to attend Training Courses with pay (ACAS Code of Practice – “Time Off for Trade Union Duties and Activities”).

If you are unwilling to grant paid release in respect of this request, please complete the section below.  You are advised that we may take further action to secure paid release from work in respect of this request if we feel it necessary.

Paid release will not be granted on this occasion because:

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Thank you for completing this form.  Please return to

Martin Bevan, MSc., MIOSH, Regional Health and Safety/Education Officer

Will Thorne House, 2 Birmingham Road, Halesowen, West Midlands, B63 3HP