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Direct debit mandate

Direct debit mandate form Download now: If you don't already pay your Prospect subscriptions by direct debit, or if you need to change your existing direct debit mandate for any reason - for example if you move your bank account - use this PDF version of the mandate. If you currently pay by deduction from salary, the PDF includes an instruction to your employer to cease this.
12 June 2009
If you don't already pay your Prospect subscriptions by direct debit, or if you need to change your existing direct debit mandate for any reason - for example if you move your bank account - use this PDF version of the mandate. If you currently pay by deduction from salary, the PDF includes an instruction to your employer to cease this.

Expenses forms

Branch expenditure expenses to be paid by branch Treasurer Download now: Reimbursement of branch related costs incurred by members to be paid by branch treasurer.
21 August 2008
Reimbursement of branch related costs incurred by members to be paid by branch treasurer.
Members expenses form to be paid by HQ Download now: Expense form to be used by members from 1 May 2014, with a mileage rate of 33p per mile. Please complete if you are claiming expenses for attending centrally funded meetings or branch expenses which are paid by HQ, ie NEC, NEC sub-committees, SESAC, RMG National and Regional Committees, Heritage Group, TUC, STUC, Blackworkers Conference, BT Committee, Scottish Power branch etc.
02 May 2014
Expense form to be used by members from 1 May 2014, with a mileage rate of 33p per mile. Please complete if you are claiming expenses for attending centrally funded meetings or branch expenses which are paid by HQ, ie NEC, NEC sub-committees, SESAC, RMG National and Regional Committees, Heritage Group, TUC, STUC, Blackworkers Conference, BT Committee, Scottish Power branch etc.

Benevolent fund

Benevolent fund application form Download now: All current or retired members of Prospect and their dependants are eligible to apply for financial assistance from the Prospect Benevolent Fund. This is the application form.
12 June 2009
All current or retired members of Prospect and their dependants are eligible to apply for financial assistance from the Prospect Benevolent Fund. This is the application form.

Personal injury scheme

Personal injury scheme: occupational stress claim form Download now: Use this form if you want to pursue a compensation claim for occupational stress. These cases are difficult to bring to a successful conclusion; when we receive your completed form we will assess whether or not we can pursue a claim on your behalf. Please note that this form cannot be completed on-screen - you will have to print it out and complete it by hand.
02 February 2009
Use this form if you want to pursue a compensation claim for occupational stress. These cases are difficult to bring to a successful conclusion; when we receive your completed form we will assess whether or not we can pursue a claim on your behalf. Please note that this form cannot be completed on-screen - you will have to print it out and complete it by hand.
Personal injury scheme: industrial deafness claim form Download now: Use this form if you want to submit a claim for industrial deafness/tinnitus where this is the result of exposure to noise at work, and where you feel your employer is to blame. (MOD members please note that you are covered by a separate scheme and this form is not appropriate.) This form is in PDF format but cannot be completed on-screen; you will have to print it out and complete it by hand.
02 February 2009
Use this form if you want to submit a claim for industrial deafness/tinnitus where this is the result of exposure to noise at work, and where you feel your employer is to blame. (MOD members please note that you are covered by a separate scheme and this form is not appropriate.) This form is in PDF format but cannot be completed on-screen; you will have to print it out and complete it by hand.
Personal injury scheme: clinical negligence claim form Download now: Prospect does not fund clinical negligence cases all the way to trial, but we offer a service that will provide you with initial advice on your case following investigation by the solicitors. If the solicitors recommend that you proceed with the litigation they will then discuss with you options for funding the case. This form is in PDF format but cannot be completed on-screen; you will have to print it out and complete it by hand.
02 February 2009
Prospect does not fund clinical negligence cases all the way to trial, but we offer a service that will provide you with initial advice on your case following investigation by the solicitors. If the solicitors recommend that you proceed with the litigation they will then discuss with you options for funding the case. This form is in PDF format but cannot be completed on-screen; you will have to print it out and complete it by hand.
Personal injury scheme: accident disease claim form Download now: This is the main claim form for assistance under our personal injury scheme. (Please note that there are separate forms for occupational stress, industrial deafness and clinical negligence.) It should be printed out and completed by hand.
02 February 2009
This is the main claim form for assistance under our personal injury scheme. (Please note that there are separate forms for occupational stress, industrial deafness and clinical negligence.) It should be printed out and completed by hand.
 
 

Health and safety forms (some are for reps only)

Accident investigation or dangerous occurrence report form, ESI sector Download now: This form is for safety reps in the electricity supply industry to report an accident investigation or dangerous occurrence.
14 January 2013
This form is for safety reps in the electricity supply industry to report an accident investigation or dangerous occurrence.
F2533/4 safety rep inspection/report form for stress from long hours culture Download now: A draft safety rep form for use when staff are working long hours AND there is evidence of this causing stress and risk of human error. Blank forms downloadable from https://www.hse.gov.uk/forms/incident/f2533-f2534.doc
13 March 2014
A draft safety rep form for use when staff are working long hours AND there is evidence of this causing stress and risk of human error. Blank forms downloadable from https://www.hse.gov.uk/forms/incident/f2533-f2534.doc
F2533/4 safety rep inspection/report form for stress from poorly managed change Download now: A draft safety rep form for use when change is being poorly managed AND the employer has failed to consult safety reps in accordance with the 1977 SRSC Regulation 4A. Blank forms downloadable from https://www.hse.gov.uk/forms/incident/f2533-f2534.doc
13 March 2014
A draft safety rep form for use when change is being poorly managed AND the employer has failed to consult safety reps in accordance with the 1977 SRSC Regulation 4A. Blank forms downloadable from https://www.hse.gov.uk/forms/incident/f2533-f2534.doc
Inspection and report form Download now: Use this after an inspection to notify your employer of unsafe or unhealthy conditions or working practices
25 January 2013
Use this after an inspection to notify your employer of unsafe or unhealthy conditions or working practices
Notification of health and safety inspection Download now: Use this form to notify management that you intend to carry out a health and safety inspection.
14 January 2013
Use this form to notify management that you intend to carry out a health and safety inspection.
Prospect asbestos register form Download now: If you've been exposed to asbestos at work, use this form to record the details. We'll add them to our asbestos register for use in any future compensation claims, either on your own behalf or your colleagues.
15 October 2013
If you've been exposed to asbestos at work, use this form to record the details. We'll add them to our asbestos register for use in any future compensation claims, either on your own behalf or your colleagues.