Home

TSA Application for Competent Persons Queensland Only


* Indicates Required Information

ORGANISATION FOR WHICH YOU WORK

*Organisation Name:
Organisation Structure:
*Organisation ABN:
*Address Line 1 (physical address):  
Address Line 2:  
*Suburb:
*Post Code:


Postal Address (if different):
P.0. Box No.:  
Suburb:
Post Code:


*Contact Name:
Job Title:
*Phone No. (not mobile):
Mobile No.:
*Contact Email:
*Re-enter Contact Email:
Second Email:
*Type of work performed:
How did you find The Safety Alliance?:


APPLICANT DETAILS

*Full Name:
*DOB:
*Place of Birth:
*Phone No.:

Documents detailed below can be scanned and emailed or faxed to us:

Email to paul@safetyalliance.com.au
Fax to 07-3102-9111


Identification - Please select sufficient of the following documents to add to a total of 100 points.
100 Points Items
Birth Certificate (extract will suffice)

Reference No: State: Document to be sent via:
Current Australian passport issued by the Australia Passport Office or an Australian passport that expired within the last two years

Passport No: Expiry: Document to be sent via:
Current overseas passport or overseas passport that expired within the last two years)

Passport No: Country: Expiry:

Document to be sent via:
Australian naturalisation or citizenship document or immigration papers issued by the Commonwealth Department of Immigration and Multicultural and Indigenous Affairs

Reference No: Document to be sent via:
40 Points Items
Current Australian driver's licence with photograph or 18+ card (or equivalent)

Licence No: State: Expiry:

Document to be sent via:
Pension Concession card, Department of Veteran's Affairs entitlement card, Senior's Health Card or any other entitlement card issued by the Commonwealth, State Government or Centrelink.

Card No: Expiry: Document to be sent via:
25 Points Items
Current credit card, or account card from a bank, building society or credit union.

Card No: Document to be sent via:
Passbook from a bank, building society or credit union.     Document to be sent via:
Telephone, gas or electricity bill up to one year old, where name and address match those on this application.

Document to be sent via:
Driver's licence (foreign) (must have photograph)

Licence No: Country: Expiry:

Document to be sent via:


Are you applying for recognition of prior learning?   Yes No
Please Advise
Are you applying for assistance with special needs?   Yes No
Please Advise
Do you require assistance with learning, literacy needs?   Yes No
Please Advise
Class of work applied for:
Demolition
Friable Asbestos

Qualifications HeldInstitutionDate Gained
ACADEMIC (NOT MANDATORY)
Engineer 
Diploma in Construction 
Architect 
Cert III OHS 
Cert IV OHS 
Cert III Demolition 
Other: Add more
Other QualificationsInstitutionDate Gained 
General Safety Induction (30215) 
Bound Asbestos Removal 
Workplace Health & Safety Officer (30596) 
Demolition Theory (30765) 
Old Course Demolition Supervisor 
Other State Course (provide certificate) 
Encapsulate & Remove Asbestos (30764) 
Encapsulate & Remove Asbestos (30230) 
White Card Safety Induction 
High Risk Work Licence
- Excavator 
- Bobcat 
- Crane 
Other: Add more

Work History


YrDuration of
Employment		PositionDutiesEmployerLocationContact
Person		Contact
Details
Click here to Add Another

Project History

Detail at least 10 projects (5 Major)
(Please note: previous employers will be contacted for verification.
If applying for both demolition and asbestos you must provide details of of projects for each task.)
Your name:  

PROJECT
Contractor name:
Contact Person:
Project:
Contact Number:
Location:
Height of Structure: metres
Duration of Project:
Year of Project:
Value of Project: $
Task: Demolition Asbestos Removal
Describe the Project:
Describe work methodology:
Your job description:
What machinery was used: (not required for asbestos)
Crane Excavator
Bobcat Loader
Concrete Saw Scaffold
Crushing Plant Rockbreaker
Demolition Ball Dozer
Concrete Buster Gantry

Which of the following were you responsible for:
Engage workers Engage subcontractors
Write Work Method Statements Write work procedures
Conduct risk assessment Conduct safety inspections
Monitor & review Provide training to workers
Supervision of workers Supervision of plant
Conduct site inductions Obtaining demolition permits
Obtaining permit to work over footpath Liasion with engineer
Identify structural integrity of a building Liase with explosives expert
Identify concealed services Locate & identify hazardous substances
Locate storage facilities Identify ingress & egress points
Identify & establish fencing needs Conduct dilapidation report
Establish demolition methodology Establish emergency procedures
Establish communication systems Daily inspection of site prior to closure
Daily inspection of site prior to commencement Ensure safety of public

Add Another Project

Please fax a copy of all training certificates, licences, references from clients or employers, copy of identification to fax number 07 3102 9111

I declare that the information I have provided is correct: Yes

Name: Date:



Web Services