Northparkes Mines Volunteer Request Form

About the program

The Northparkes Volunteer Leave Program was designed in 2013 with the principle that the best contribution to our community could be made by our people. Through the skills our workforce brings to the Central West, we can provide assistance to businesses and organisations they may not otherwise have access to.

Please complete the following form to help us determine whether we can assist with your project. If we are able to assist, the information you provide will help identify the most appropriate team for the job, and will ensure we can safely undertake the tasks requested.

Please contact Ali on ali.creith@northparkes.com or (02) 6861 3621 if you have any questions about the program or this form.

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* 1. Your contact details (we will use this information to contact you regarding your volunteer project):

Name *

Company

Address

Address 2

Town (the program operates within Central West NSW)

Postcode

Email Address *

Phone Number *

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* 2. Briefly describe the volunteer project and its community benefits:

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* 3. What date is the volunteer activity taking place? (If flexible, leave blank).

Proposed date

Date

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* 4. Project scope:

Approx number of people required

Approx number of hours required

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* 5. Does your organisation have public liability insurance?

Yes

If yes, please list the limit.

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* 6. Please list all the tasks you would like the volunteers to complete, e.g. planting trees, picking up rubbish.

Task 1

Task 2

Task 3

Task 4

Task 5

Task 6

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* 7. What tools and/or materials are you providing to complete the tasks?

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* 8. Do you require the volunteers to bring any tools?

Yes

If yes, please list tools requested/required.

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* 9. Will the volunteers be required to do any of the following (tick all that apply):

Work at heights

Operate electrical tools (e.g. drill, chainsaw)

Handle manure (including compost)

Operate manual tools (e.g. hammer)

Perform electrical work

Clean bathrooms/toilets

Lift loads over 10kg

Handle chemicals (e.g. solvents, paint)