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Conduct SHENA's Registered Safety & Health Training Course Form

APPLICANT BASIC INFORMATION

Applicant's Name (Focal Point between SHENA & Training Provider)

Position / Designation

Contact No.

E-mail Address

Training Provider INFORMATION

Name of Training Provider

Address of Training Centre

SHENA ATP Registration Reference no.

Date of Approval by SHENA

Training Course & Assessment

Please include along:

Course lesson plan that shows the plan and time allocated for the delivery of each topic
Complete/ Full Timetable of the course delivery
Training/ Lecture Notes (6 slides in 1 page)
Assessment used to deliver the training course

For part time/ invited trainer, there should be:

Letter of appointment from the training provider for the trainer.
Letter of agreement from the invited trainer who agree to conduct the training course at your training provider.

Information of Training Course Trainer

Total no. of Trainers

Important Notes

Supporting Documents

Documents to be uploaded

Upload document(s)

Curriculum Vitae of the trainer

Copy of IC of trainer

Course lesson plan that shows the plan and time allocated for delivery of each topic

Complete/ Full Timetable of the course delivery

Training/ Lecture Notes (6 slides in 1 page)

Copy of Assessment used to deliver the training course

I, declare that all particulars and information provided in this application and the documents attached hereto are true to the best of my knowledge and belief, and I understand that the Safety, Health and Environment National Authority (SHENA) reserves the right to reject this application if, at any stage, the information provided is false and incorrect. Should verification be required on any information provided in this application, I hereby authorise SHENA to carry out the necessary investigations.

Declaration of Complainant

Yes

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