CHPP Induction and Authorisation Request

CHPP Induction and Authorisation Request
Full Name *

First Name Last Name
Pegasus ID *
Date of Birth *

Day Month Year
Phone Number *

Area Code Phone Number
Email *
example@example.com
Vehicle Registration Number *
As it appears in the Australian Business Register
Job Title *
Requested Induction Date *

Day Month Year
Minimum Induction Requirements *

State Drivers Licence Order 43 Medical Drug & Alcohol Screen Role Qualification(s) Letter of Competency (Employer Issued) Appointment Request*
*Mechanical and Electrical roles require separate appointment - refer to MPO Maintenance Skills Matrix for appointment /authorisation requirements
Competencies / Skills / Tasks / Activities to be conducted on site

Please detail competencies / skills / tasks / activities to be conducted on site by the Inductee - evidence of training and experience must be provided with all evidence current and legible
Company / Employer *
Company Contact *

First Name Last Name
Company Contact Phone Number *

Area Code Phone Number
Company Contact Email *
Approval / Rejection will be sent to this email address
Work to be Performed *
Work Start Date *

Day Month Year
Date *

Day Month Year
Date
Will you be performing Electrical and/or Mechanical work on-site? *
Please ensure the relevant Appointment form(s) is submitted with your induction request.

Mechanical Appointment Letter
Electrical Appointment Letter
From the list below, please select the activities you will be performing on site: *

Operating a light vehicle Operating an ITC Operating a loader Operating a gantry crane Operating a skid steer loader Operating an excavator Dogging or Rigging Operating an EWP Working in a confined space Working at heights None of the above
To perform these duties, you will need Site Authorisation. Please download and complete this form and return it to mtpleasant.admin@sedgman.com prior to attending site.
Approver Password
Site Access Pre-Approval Sign-Off *

Approve the candidate to attend the CHPP Induction Reject the candidate
Authorisor *
Date *

Day Month Year
Date
Should be Empty: