CHPP Induction and Authorisation Request

CHPP Induction and Authorisation Request
Full Name*

First NameLast Name
Pegasus ID*
Date of Birth*

DayMonthYear
Phone Number*

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

DayMonthYear
Minimum Induction Requirements*

State Drivers LicenceOrder 43 MedicalDrug & Alcohol ScreenRole 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 NameLast Name
Company Contact Phone Number*

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

DayMonthYear
Date*

DayMonthYear
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 vehicleOperating an ITCOperating a loaderOperating a gantry craneOperating a skid steer loaderOperating an excavatorDogging or RiggingOperating an EWPWorking in a confined spaceWorking at heightsNone of the above
To perform these duties, you will need Site Authorisation. Please download and complete this form and return it to mtpleasant.chpp.inductions@sedgman.com prior to attending site.
Approver Password
Site Access Pre-Approval Sign-Off*

Approve the candidate to attend the CHPP InductionReject the candidate
Authorisor*
Date*

DayMonthYear
Date
Should be Empty: