(please refer to the Explanatory Notes when completing this application)
1
Title and position
Given names
(do not abbreviate)
Surname
(include maiden name)
Birthplace
Town
Country Date of birth
Residential address
Telephone
Postal address
(For all correspondence)
University/facility name
Registered business name (University/ facility)
Australian Business
Number (ABN)
School (or equivalent) name
Location (Street address)
Real Property
Description (RPD)
Lot number
Plan
Parish
Local government
Postal address
Contact person
(if different to applicant)
Telephone (not mobile)
Mobile
E-mail
E-mail
1 The custodian is the authorised person responsible for the management and operations of the facility for which this application relates.
Page 1 of 6
FORM 2 – Notification of variation to established school of anatomy details – V1 OCT 2012

2
Change of name for the school of anatomy (provide details of new name and current name in authorisation)
Change of name of building(s) that make up the school of anatomy (provide details of new name and old name)
Relocation of whole school of anatomy to new premises. Provide details of new premises including:
Real Property Description (RPD)
Lot number
Plan
Parish
Local government
Relocation of a building in the school of anatomy to new premises. Provide details of new premises including:
Real Property Description (RPD)
Lot number
Plan
Parish
Local government
Currently authorised school of anatomy will no longer function (include date) as:
An accepting school, for a body. Meaning a school of anatomy that—
(a) accepts the body under an authority; and
(b) has not borrowed the body from a lending school.
A lending school, for a body. Meaning—
(a) an accepting school for the body; or
(b) an interstate lending school for the body or a part of the body.
.A borrowing school, for a body or a part of a body. Meaning a school of anatomy that
borrows the body or part from—
(a) the accepting school for the body for a purpose for which retention of the body is authorised; or
(b) an interstate lending school for the body or the part.
Any other variation details in addition to the above.
2
Notification of variation to an established school of anatomy under section 37 of the Transplantation and Anatomy Act 1979
(Queensland) where the study and practice of anatomy may be carried on in connection with a university or school of medicine in a place considered fit by the authoriser.
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FORM 2 – Notification of variation to established school of anatomy details – V1 OCT 2012

3
Provide full documentation on the following (include policies, procedures, operating instructions rationale etc):
System for the delivery of bodies and body parts
System for the receipt of bodies and body parts
System for the storage and security of bodies and body parts
System for the handling of bodies and body parts
System for the tracking of bodies and body parts
Laboratory environment and equipment
Preparation room environment and equipment
Physical properties and capabilities for example:
Enhanced thermal insulation for the avoidance of condensation (as the lab may be cooled to 18 degrees C)
Enhanced vapour seal via air lock doors, sealed light fittings, plasterboard ceilings etc (so e.g. so any odours are sealed within the lab and don't seep into the neighbouring teaching spaces etc)
Improved low level air extraction to ensure chemical levels (e.g. of formaldehyde) remain within acceptable workplace health and safety levels
Electronic purge system on cold room doors to prevent chemical (e.g. formaldehyde) exposure
Body/body parts delivery process for transporting from enclosed delivery bay area to the laboratory which restricts staff and students from viewing during transportation
Operating instructions and guidance for persons performing anatomy.
Operational and record keeping practices that meet the requirements the Transplantation and Anatomy Act 1979 and the Transplantation and Anatomy Regulations 2004 including
Building approval and fit out - legislative and other requirements have been met.
Workplace Health and Safety Queensland - legislative and other requirements have been met.
3
Please note that each School of Anatomy retains responsibility for obtaining their own legal advice with respect to the relevant legislation (including but not limited to workplace health and safety, buildings, the Transplantation and Anatomy Act 1979 and the
Transplantation and Anatomy Regulations 2004 and its application.(Disclaimer)
.
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FORM 2 – Notification of variation to established school of anatomy details – V1 OCT 2012

Provide full documentation on the following (include policies, procedures, operating instructions rationale etc):
Access to the facility - Specify the types of students and staff who will use the facility and their approximate number per year. Outline the proposed security process for ensuring only bona fide students and staff (as specified) has access to the facility.
Proposed anatomical activities – This is information on the range of activities to be undertaken in the facility and may be prefaced by a general statement. For example, “The study and practice of anatomy within the terms of the
Transplantation and Anatomy Act 1979 and the Transplantation and Anatomy Regulations 2004 using tissues for the purposes of anatomical dissection and surgical technique.”
Accessing cadaver material - Outline the proposed process for obtaining cadaver material, including details of the facilities where tissue may be sourced from.
Registering tissues/specimens - Outline the proposed process for registering all tissues and specimens.
Disposal of tissues/specimens - Outline the proposed process for the disposal of tissues/specimens as determined by a range of legislative the requirements including the Transplantation and Anatomy Act 1979 and the Transplantation
and Anatomy Regulations 2004.
Ethics – statements of support from referees and suitable human ethics committee.
This section is to be completed by the applicant’s supervisor or employer.
The applicant is employed by
I support this application.
(applicant’s name)
(employer’s name)
Name in full
Position
Telephone
Signature
Email
Date
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FORM 2 – Notification of variation to established school of anatomy details – V1 OCT 2012

Have you - been convicted of an indictable offence?
(Drink driving and minor traffic offences are not indictable offences) been convicted of an offence against any existing health law or a repealed provision or a corresponding law? held an approval granted under a health law or a repealed provision or a corresponding law that was suspended or cancelled? ever been refused an approval under a health law or a repealed provision or a corresponding law?
Yes
Yes
Yes
Yes
No
No
No
No
If YES to any of the above, please attach documentation that provides details of the suspension, cancellation, refusal, nature of the offence and the circumstances of its commission or Board details.
I declare that the information stated by me on this notification form is true, correct and complete. Yes No
I consent to the making of enquiries of, and the exchange of information with the authorities of any State, Territory or Commonwealth regarding any matters relevant to this application.
I read, understood and agree to comply with my obligations required under the relevant provisions of the Transplantation and Anatomy Act 1979 and Transplantation and Anatomy
Regulation 2004 and additional requirements of the authoriser and inspectors under the Act.
(Legislation available online at www.legislation.qld.gov.au) .
Yes
Yes
No
No
Signature 1
Date
Position
NOTE YOU MUST:
 KEEP A COMPLETED AND SIGNED COPY OF THIS APPLICATION AND OTHER SUBSEQUENT RELATED
DOCUMENTATION FOR RECORD AND INSPECTION PURPOSES; AND
 NOTIFY QUEENSLAND HEALTH EVERY TIME THERE ARE ANY CHANGES TO THE LATEST DETAILS PROVIDED USING
THE FORM “Notification of variation to established school of anatomy details - section 37 of the Transplantation and
Anatomy Act 1979”.
DATE APPLICATION RECEIVED
(To be stamped and signed)
(Insert DD/MM/YYY)
Further information required to process application
ACTION TAKEN
Referred to Queensland Health committee for action
RESPONSE PROVIDED TO APPLICANT
(on action taken above – attach copy) (Insert DD/MM/YYY)
Page 5 of 6
FORM 2 – Notification of variation to established school of anatomy details – V1 OCT 2012

This information has been prepared to assist you in applying for authorisation to establish a school of anatomy under section 37 of the Transplantation and Anatomy Act 1979.
1.
Complete this form clearly on computer and answer all questions in full.
2.
Applications are processed only when all the information requested is provided. You will be notified by post if the approval is granted.
3.
All forms requiring a signature must bear the original signature in ink. Queensland Health is not able to accept a
photocopy, facsimile (fax) or emailed copy of the completed form. Applications must be forwarded by POST to the address details provided below.
4.
Queensland Health manages personal information in line with the Information Privacy Act 2009. The collection and use of any personal information in this form will be for the purposes of assessing your suitability to establish a school of anatomy/ make variations to an established school of anatomy.
5.
Access by other Queensland Health staff is limited to what is necessary to undertake associated administrative requirements. Queensland Health will not add you to a mailing list, or give your personal information to third parties without your consent, unless required by law
LODGING APPLICATIONS
All applications are to be addressed to:
Chief Health Officer
Schools of Anatomy
Chief Health Officer Branch
PO Box 2368
FORTITUDE VALLEY BC QLD 4006
Transplantation and Anatomy Act 1979
 school of anatomy means a school of anatomy established or declared to be established under the authority of section 37.
Transplantation and Anatomy Regulation 2004
 body means the body of a deceased person.
 accepting school, for a body, means a school of anatomy that—
(a) accepts the body under an authority; and
(b) has not borrowed the body from a lending school.
 lending school, for a body, means—
(a) an accepting school for the body; or
(b) an interstate lending school for the body or a part of the body.
 borrowing school, for a body or a part of a body, means a school of anatomy that borrows the body or part from—
(a) the accepting school for the body for a purpose for which retention of the body is authorised; or
(b) an interstate lending school for the body or the part.
 inspector means a person appointed under section 38(1) of the Act as an inspector of schools of anatomy.
Further information may be available from Queensland Health’s website at www.health.qld.gov.au/health_professionals/default.asp
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FORM 2 – Notification of variation to established school of anatomy details – V1 OCT 2012