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Application to Register as Workplace Safety and Health Co-Ordinator

APPLICANT'S DETAILS

APPLICATION TYPE

New

Renewal

DETAILS OF APPLICANT

Applicant's Name (as per IC / Passport)

IC No. (For Brunei Citizen, Permanent Resident or Temporary Resident) / Passport No (Foreign Application)

IC Colour

Date of Birth

Gender

Male

Female

Residential Address

Mailing Address

Same as residential address

Contact No. (Mobile Number)*

Contact No. (Office Number)*

E-mail Address

WORKPLACE DETAILS

Current Job Position / Title

No. of Years & Months working in Current Job Position

Name of Company

Workplace Industry Classification

Company's Address

WORKPLACE SAFETY AND HEALTH (WSH) QUALIFICATION

WSH Qualifications

LIST OF PREVIOUS EMPLOYMENT

Company	Job Position	Duration

SUPPORTING DOCUMENTS

Documents to be uploaded

Upload document(s)

Minimum IOSH Managing Safely or NEBOSH Health & Safety at Work Award or Other Workplace Safety and Health Relevant Qualification

Applicant Identity Card (IC) (for Brunei Citizen, Permanent Resident or Temporary Resident) / Passport No (for Foreign application)

Curriculum Vitae (CV)

Letter of Appointment/ Nomination of the individual appointed by the company as WSH Co-Ordinator

Certificate of other relevant Workplace Safety and Health Certificate

Evidence of CPD (Continuing Education) - 30 hours minimum

Evidence of CPD (Delivering & Teaching) - 30 hours minimum

Evidence of CPD (Inspection, Audit & Review) - 30 hours minimum

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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