Ambassador workplace visit application

Ambassador attendance is subject to approval and availability. Please allow a minimum of four weeks between submitting your request and your proposed event date. Please note, you may experience a delay in application processing in periods of high requests such as October, or if information submitted is incomplete.

Success: Form submitted

Error: Form submission failed. Please review your form details and try again.

Required fields are marked with an asterisk (*).

Your details

First name *

Last name *

Phone number *

Email address *

Job title

Your business/organisation

Business name *

Industry type *

If Other, please describe

Your event

Event name *

Date *

Start time *

Hour Minute

End time *

Hour Minute

Event type *

If Other, please describe

Event address

Address *

Suburb *

State *

Postcode * Must be 4 digits.

Ambassador

Preferred Ambassador *

Proposed presentation duration (minutes) * Between 40 minutes and 1 hour.

Proposed event program * Have you held this event before? Who is speaking, what topics are being discussed, why are you holding the event etc. Is your event is part of a broader campaign (e.g. supporting Safe Work Month or Mental Health Week)?

Upload proposed event program * You will also need to upload a Word document (doc or docx) of no more than 20 MB in size that outlines your run sheet/speaking program and times. You can also provide a link to an online speaker program, website or any event promotions if you wish.

Attendance

How many people will attend? * Minimum 100 people.

Who will be attending? * Your supply chain, industry partners, neighbouring companies, other industry organisations etc? Please detail organisations and attendee demographics (e.g. industry, job title, etc).

Requirements

Industry support * Is your event supported by industry and/or industry bodies? Are you working in partnership with any other organisations to deliver this event? Does your event encourage industry/community engagement in work health and safety initiatives?

Organisation reputation * Tell us a little about your organisation and how the event fits within your organisation (e.g. is this part of Safe Work Month, Mental Health Week, regular activity in your workplace, as a result of recent safety incidents/near miss etc).

Free to attend * Your event should be free for participants to attend.

Are you planning any media for your event (e.g. media releases or media in attendance)? *

If Yes, please describe Will you require any quotes or media interviews with our Ambassador?

Have you requested an Ambassador visit before? *

If Yes, please describe Did an Ambassador attend? Who did they speak to? When was the event? What was the feedback?

Acknowledgements * You will provide credit to Workplace Health and Safety Queensland in the program where the Ambassador is noted or introduced.

I agree

Filming * No audio recording or filming is permitted during Ambassador presentations and appearances.

I agree

Evaluation * If your application is approved, you agree to complete a short evaluation survey post event?

I agree

Privacy statement

The Office of Industrial Relations is collecting your personal information for the purposes of responding to your registration request. Your personal information may also be used for the purpose of reviewing our client service performance and standards.

Ambassador workplace visit application

Privacy statement

Rate your experience

How to guides

For service providers