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TSA Appointment of PQC Auditor (QLD)

* Indicates Required Information

*Project Client Q Build
Qld Public Works
Main Roads Qld
Other (please specify)
*Contractor Details
PC Name ABN
Business Address
Phone Number  
Email Re-enter Email

Project Details (For Specific Project Request)
Project Name
Project Reference Number Job Number
Contract Duration Acceptance Date
Site Address
Contact Person Contact DetailsPhone:
Email:

*Context of Service
Pre-Accreditation Ongoing Monitoring Renewal of Accreditation
Other(please specify)

*Nature of Service Required
OHSMS Audit (please include details below)
Date Audit Required By Contact Person Contact DetailsPhone:
Email:
Audit Context Pre-Accreditation Renewal of Accreditation
Audit Scope Single Office Multiple Office
List of Multiple Offices
(if applicable)
Construction Safety Plan Assessment
Site Inspection


*Project Superintendant
Name Phone
Mobile Email

WHS Auditor (Construction) Response to Offer
*Auditor Name Accreditation Number
Auditor Phone Auditor Email

The PQC Auditor will complete the highlighted sections.
Response to Offer Accept Decline
Timeframes Date of OHSMS Audit
Date of Construction Safety Plan Assessment*
Week of Site Inspection
Expected Duration Expected Cost
Signature Date
*PQC only


The PQC Auditor will complete the highlighted sections.

The Contractor
The WHSQ Safety Program Administrator (whsadmin@deir.qld.gov.au)
The PQC Registrar (pqcregistrar@publicworks.qld.gov.au) or The ESAP Administrator (esap@mainroads.qld.gov.au)
The Project Superintendant stated above

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

Name: Date:





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