SHENA - Approved Training Provider Form

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Application to act as an Approved Training Provider

TYPE OF APPLICATION

Type of Application*

New Application* Renewal*

APPLICATION BASIC INFORMATION

This will be the focal person for any matters related to approval to act as a Training Provider

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

Contact No.*

Email Address*

TRAINING PROVIDER BASIC INFORMATION

Name of Company (As per the Company Registration Letter/ Certificate)*

Company Registered / Mailing Address*

Address of Training Provider (for theory session)*

Address of Training Provider (for practical session)

Company Official Contact No.*

Company Official Email Address*

Managing Director Details

Name of Managing Director / CEO*

Contact No.*

Email Address*

TRAINING PREMISES & FACILITIES INFORMATION

A) Does the training provider have a permanent or rented location to provide the training?*

No* Yes*

B) If Yes, please upload the following:

Photographs of the training premise/ classroom/ facilities/ practical site

Photo/ List of equipment used for practical session (if applicable)

Certification of equipment used for practical session (if applicable)

C) If No, please describe how your training provider will deliver the training.

Upload any agreement letter to support the use of facilities as mentioned

LIST OF TRAINING COURSE(S) OFFERED

Name of Training Course	Type of Course (Awareness or Competency)	Standard Followed (if any)	Mode of Delivery (Theory/Practical/Both)	Duration (No of Days)	Medium of Instruction (Language)	Accreditation or Certifications (if any)	Maximum number of participants per course	Course Information & Objectives	Course Lesson Plan/ Timetable/ Schedule of Course Delivery	Lecture Notes/ Course Materials used to deliver the course note: if it is using Powerpoint Slides, please arrange 6 slides in 1 page to reduce size of the uploaded file.	Assessment used for the course (if applicable)

DETAILS OF TRAINER

Full Name	Passport / Identity Card No. (Colour)	Date of Birth	Highest Academic Qualification	Trainer Qualification (i.e. Train the Trainer Certificate)	Mode of employment with your training provider	Upload copy of employment letter (for full time trainer) Indicate which training course is taught by the instructor.	Letter of appointment from the training provider for the trainer (for part time trainer) Indicate which training course is taught by the instructor.	Letter of agreement from the invited trainer who agree to conduct the training course at your training provider (for part time trainer) Indicate which training course is taught by the instructor.	No. of Years & Months of Working Experience (in total)	No. of Years & Months working in Health & Safety Profession (if any)	Latest CV	Relevant Certificate (Please compile all the relevant certificates in 1 single PDF file)

DETAILS OF ASSESSOR

Full Name	Passport / Identity Card No. (Colour)	Date of Birth	Highest Academic Qualification	Assessing Qualification (e.g. Competent Assessor)	Mode of employment with your training provider	Upload copy of employment letter (for full time assessor). Indicate which training course is assessed by the assessor.	Letter of appointment from the training provider for the trainer (for part time assessor). Indicate which training course is assessed by the assessor.	Letter of agreement from the invited trainer who agree to conduct the training course at your training provider (for part time assessor). Indicate which training course is assessed by the assessor.	No. of Years & Months of Working Experience (in total)	No. of Years & Months working in health & Safety Profession (if any)	Latest CV	Relevant Certificate (Please compile all the relevant certificates in 1 single PDF file)

DETAILS OF VERIFIER

Full Name	Passport / Identity Card No. (Colour)	Date of Birth	Highest Academic Qualification	Verifier Qualification (e.g. Audit certification)	Mode of employment with your training provider	Letter of appointment from the training provider for the trainer (for part time verifier).	Letter of agreement from the invited trainer who agree to conduct the training course at your training provider (for part time verifier).	Upload copy of employment letter (for full time verifier).	No. of Years & Months of Working Experience (in total)	No. of Years & Months working in Health & Safety Profession (if any)	Latest CV	Relevant Certificate (Please compile all the relevant certificates in 1 single PDF file)

SUPPORTING DOCUMENTS

Note: Please compile the documentation/ photographs/ certifications in 1 single PDF file for each category listed below

A. BUSINESS PROFILE

Training Provider Organisational Chart*

Company Registration Certificates*

Training Provider Occupational Safety & Health Policy*

B. EVALUATION & CERTIFICATE

Copy of Course Evaluation Form / Feedback Form for Candidates*

Sample Copy of Certificate Awarded to Successful Candidates*

Guidelines / Process of Giving Out Certificates

C. EMERGENCY PROCEDURES (for training provider with permanent/ rented premise)

Emergency Evacuation Layout Plan

Documented procedures in the event of emergencies*

Photographs of Emergency Equipment (e.g. Fire Extinguisher [with inspection tag], Fire Alarm, Fire Hose Reel [if applicable], First Aid Box, etc.)*

List of Appointed Fire Marshal / First Aider (with certificates)*

Copy of Training Provider’s Safety & Health Induction to participants*

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 Applicant

I agree

Please check the box below to proceed