Please complete this form if you have been re-elected as a Safety Rep for the same employer. If you have any queries, please contact Gill Feldman on 020 7306 6682 or email feldmang@csp.org.uk

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* CSP Number

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* Date of Re-election

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* Name (as appears on CSP database)

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* Workplace Information - this is the building you are primarily based at for work purposes

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* Telephone Details - please provide the phone contact details you are happy to be passed on to members seeking workbase advice

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* Email Address - please provide an email address that you are happy to be passed on to members seeking workbase assistance

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