HSE OFFICER APPROVAL APPLICATION

ZA-DC-F-34 Issue 7, Rev 0, Dated 22/11/2017 Page 1 of 2

For New Registration:Below documents to be scanned in colorand submitted in a CD

1. Copy of passport with valid visa page2. Passport-size photograph3. Detailed CV4. Copy of attested educational certificates5. Copy of experience certificate(s)6. Copy of HSE qualification certificates

For Renewal:1. Copy of passport with valid visa page

For Employer Change: 1. Copy of passport with valid visa page2. Existing registration card (if not expired)

For Upgrade Position:1. Copy of passport with valid visa page2. Existing registration card (if not expired)

For Replacement of Lost / Damaged Card: NA

For Linking/Delinking Plots:1. Link Delink2. If Link, Plot No(s). to be linked:

If Delink, Plot No(s). to be delinked: For HSE Officer App Username Change:1. Copy of passport with valid visa page (if not submitted previously)2. Existing username (e-mail address)

New username (e-mail address)

HSE OFFICER’S ID NO# (if any) PLOT NO.

CONTRACTOR NAME

SUBMISSION TYPE

New Registration RenewalEmployer Change Upgrade Position

Replacement Of Lost/Damaged Card Linking/ Delinking PlotsHSE Officer App Username Change

DOCUMENTS REQUIRED

SR. NAME OF INSTITUTION LOCATION COURSEPERIOD

FROM TO

QUALIFICATIONS:

ZA-DC-F-34 Issue 7, Rev 0, Dated 22/11/2017 Page 2 of 2

SR. NAME OF INSTITUTION LOCATION POSITIONPERIOD

FROM TO

EXPERIENCE:

Note: DCCA Zoning Division shall bear no liability in registration of “HSE Officer” for genuinity of the attested educational certificates. Requestor (HSE Officer) shall bear the full liability incase of forged educational certificates

NAME

MOBILE

E-MAIL

DATE

SIGNATURE

STAMP

HSE OFFICER DETAILS

NAME

MOBILE

E-MAIL

DATE

SIGNATURE

STAMP

CONTRACTOR DETAILS