Form A80
APPLICATION FOR APPEAL AGAINST
DISCIPLINARY DECISION (FIRE AND
EMERGENCY SERVICES)
Case Number
(SAET use only)
About this form

This is the approved form for an officer or firefighter who is aggrieved by a decision of the Disciplinary
Committee or the Chief Officer to appeal the decision under section 49 of the Fire and Emergency Services
Act 2005.

An appeal must be lodged within 14 days of the decision.

Submitting an incomplete form (including any relevant supporting documents) may result in delays.
CASE AND PARTY SUMMARY
In the matter of an appeal against a disciplinary decision under section 49 of the Fire and Emergency Services
Act 2005:
Appellant(s) (name)
Respondent (name)
Date of the decision
Describe the decision:
PARTY DETAILS
Applicant
☐ Mr
Title
First name
☐ Mrs
☐ Miss
☐ Ms
☐ Other (specify):
Last name
Email
Telephone
Mobile
Address
Street 1
Street 2
Suburb
State
Postcode
Country
Do you require an
interpreter?
☐ No
☐ Yes. Please specify language:
Do you haver any special
requirements which will
require assistance?
☐ No
☐ Yes. Please specify:
www.saet.sa.gov.au
SAET Registry: 08 8207 0999
Version as at 1 July 2017
1/3
South Australian Employment Tribunal
Form A80 – Application for appeal against Disciplinary decision (Fire and Emergency Services)
Is anyone representing
you?
☐ No
☐ Yes. Please specify:
Representative detail (if required)
Organisation
Contact First name
Last name
Email
Telephone
Address
Mobile
Street 1
Street 2
Suburb
Postcode
State
Country
Respondent
Organisation
Title
First name
Last name
Email
Telephone
Mobile
DETAILS OF APPEAL
Orders sought
Specify the orders that you seek (if insufficient space, set out orders sought in a schedule attached to this
application).
www.saet.sa.gov.au
SAET Registry: 08 8207 0999
Version as at 1 July 2017
2/3
South Australian Employment Tribunal
Form A80 – Application for appeal against Disciplinary decision (Fire and Emergency Services)
Grounds and reasons
Specify the grounds and reasons in support of this application (attach additional pages if necessary):
Extension of time
Is this application within 14 days after notice of the nomination?
☐ Yes
☐ No, specify reasons why:
LODGING YOUR COMPLETED FORM
The person lodging this form must send a copy to all other party/ies.
Name of person lodging
Signature
Date
Please lodge this form, together with any accompanying documents, with the South Australian Employment
Tribunal:
Email: [email protected]
Post: PO Box 3636, Rundle Mall, SA, 5000
In person: Level 6, Riverside Centre, North Terrace, Adelaide, 5000
PLEASE RETAIN A COPY OF THIS FORM FOR YOUR OWN RECORDS
www.saet.sa.gov.au
SAET Registry: 08 8207 0999
Version as at 1 July 2017
3/3