Western Australian Consolidated Regulations

PRISONS REGULATIONS 1982 - SCHEDULE

Form 1

[Regs. 27, 28]

Prisons Act 1981
Prisons Regulations 1982

Superintendent,
....................................................................... Prison.

I, .......................................................................................................... (full name)
being a person appointed as an analyst under the Health Act 1911 and employed at the ................................................... (Name of approved analysis agent)

CERTIFY THAT:

        (1)         On the ................................. day of ................................. 20 ............ I received a sample of ....................................................................... from ................................................................................................... in a sealed container and bearing, inter alia ,
                ................................................................................. Prisoner’s name
                ................................................................... Officer who took sample
                .............................................................. Time and date sample taken

        (2)         I certify that I have analysed the said sample and the result of such analysis is as follows — 

                ............................................................................................................
                ............................................................................................................
                ............................................................................................................

DATED this ..................................... day of ......................................... 20 ...........

...........................................................         ........................................................
Analyst         Laboratory Number

        [Form 1 inserted in Gazette 17 Aug 1984 p. 2450; amended in Gazette 9 Aug 1991 p. 4113; 8 Nov 1991 p. 5721; 13 Sep 1996 p. 4570.]

Form 2

[Regulation 54]

Prisons Act 1981
Prisons Regulations 1982

DECLARATION UNDER SECTION 60 OF THE
PRISONS ACT 1981

IMPORTANT INFORMATION         When you make a declaration under section 60 of the Prisons Act 1981 you may be required to produce evidence of your identity.         It is an offence to make a declaration under section 60 of the Prisons Act 1981 which is false in a material particular and the maximum penalty for doing so is a fine of $1 500 or 18 months’ imprisonment, or both the fine and imprisonment.

1.         I declare that my full name and address and date of birth are .....................

        ......................................................................................................................

        ......................................................................................................................
        ( Print your given name(s) and family name, current address and date of birth )

2.         I wish to visit prisoner .................................................................................
        ( Print the name of the prisoner you wish to visit )

3.         (Complete paragraph (a), (b) or (c) if you are the prisoner’s spouse, de  facto partner, relation or friend)

            (a)         I am the prisoner’s spouse or de facto partner

                .....................................................................................
                                (State relationship to prisoner)

OR

            (b)         I am a relation of the prisoner as I am the prisoner’s

                ..............................................................................
                        (State your relationship to the prisoner)

OR

            (c)         I am a friend of the prisoner and I have known the prisoner for

                ................................................................................
( State the number of years or months that you have known the prisoner )

4.         The purpose of my visit to the prisoner is ...................................................

        ......................................................................................................................
        (State the purpose of your visit to the prisoner)

5.         I have been informed that I am required to make this declaration under section 60 of the Prisons Act 1981 and I understand that a person who makes a declaration under that section which is false in a material particular commits an offence.

        ......................................................................................................................
        (Signature of person making this declaration)

        Made the ...................................... day of .................................... 20 ..........

        In the presence of .........................................................................................
        (Print name of witness)

        ......................................................................................................................

        (Signature of witness)

        [Form 2 inserted in Gazette 19 Mar 1996 p. 1241‑2; amended in Gazette 30 Jun 2003 p. 2625‑6; 11 Jun 2004 p. 2002.]

Form 3

[Reg. 82]

Prisons Act 1981
Prisons Regulations 1982

INQUIRY BY REPORTING OFFICER

To: ..........................................................................................................................

(person required to attend inquiry)

WHEREAS on .............................................................. and pursuant to section 9 of the Prisons Act 1981 , I (A.B. ) was appointed by the chief executive officer of the Department to INQUIRE into:

................................................................................................................................
................................................................................................................................
................................................................................................................................
(here state concisely the matter, incident or occurrence concerning the security or good order of the prison or concerning the prisoner or prisoners).

AND TO REPORT upon the subject of this inquiry to the chief executive officer.

TAKE NOTICE that you are required to appear before the inquiry at .................. on ................. day, the ........................... day of .............................. and there and then give such information as may be required and to answer such questions as may be put in relation to the subject of this inquiry.

By section 10 of the Prisons Act 1981 an officer required to give any information or to answer any question and who without reasonable excuse fails to give that information or gives any information or answer that is false in any particular, commits an offence and is liable on conviction to a penalty not exceeding $300.

A prisoner who commits that offence is guilty of an aggravated prison offence and liable to be punished accordingly.

GIVEN under my hand this ........................ day of .................................. 20 .......

............................................................. (A.B. ).

        [Form 3 amended in Gazette 11 Dec 1987 p. 4369; 2 Nov 1999 p. 5475.]