Mount Pleasant Induction and Authorisation Request

Mount Pleasant 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 *
In which area of the Thiess Operation will you be working? *

Mining Maintenance Safety Environmental Technical Services Other
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
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
Approver Password
Site Access Pre-Approval Sign-Off *

Approve the candidate to attend the Mount Pleasant Induction Reject the candidate
Authoriser *
Date *

Day Month Year
Date
Should be Empty: