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Honour Roll application

Queensland Workers Memorial
Required fields are marked with an asterisk (*).
Details of person to be included on the Honour Roll

Photo uploads (optional)

Please upload up to 3 photographs. Must be no larger than 10 MB and match one of the following extensions: gif jpeg jpg png tiff.

Written tribute (optional)

Your tribute can be any length. We recommend between 200 and 1000 words. If your tribute is greater than 1000 words, please upload on a Word document (doc or docx). For help writing your tribute please read the guide or call 1300 362 128.

Uploaded file be no larger than 10 MB and match one of the following extensions: doc docx pdf.

Details of the person submitting this application
Declarations
What type of legal action? Which court the proceedings are in? When the action is expected to be resolved?
Next of kin * Are you authorised as next of kin and have the support of the individual’s family and individuals identified in the tribute to submit this information.
True and accurate * The information I have provided is true and accurate and that I am aware that providing misleading, deceptive, or false representations can amount to a criminal offence and give rise to civil liability. I acknowledge that my personal information will only be used for the purposes of administering the Honour Roll and related purposes, and will not be used for other purposes or disclosed to third parties without my consent.
Criteria for inclusion on the Honour Roll * I have read and understood the criteria for inclusion on the Honour Roll and consider that this individual meets the criteria. The criteria can be found on the Queensland Workers Memorial website.

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.

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