SHENA - Workplace Safety and Health Co-Ordinator's Application Form

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Application to Register as Workplace Safety and Health Co-Ordinator

APPLICANT'S DETAILS

Application Type*

New* Renewal*

Applicant's Name*

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

IC Colour

Date of Birth*

Gender*

Female* Male*

Residential Address*

Mailing Address

Contact No. (Mobile Number)*

Contact No. (Office Number)

E-mail Address*

FOCAL PERSON DETAILS

Focal Person Name*

Contact No*

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	Upload The Qualification Certificate

Company	Job Position	Duration

SUPPORTING DOCUMENTS

Documents to be uploaded

Upload document(s)

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 (optional)

Certificate of other relevant Workplace Safety and Health Certificate (optional)

Passport-sized Photo*

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 Applicant

I agree

Please check the box below to proceed