SHENA - Conduct SHENA's Registered Safety & Health Training Course Form

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Conduct SHENA's Registered Safety & Health Training Course Form

NAME OF SAFETY AND HEALTH TRAINING COURSE TO BE CONDUCTED (AS PER SHENA’s NTI/ RTN COURSE SYLLABUS ANNOUNCEMENT)

Name of Safety and Health Training Course*

APPLICANT BASIC INFORMATION

Applicant's Name (Focal Point between SHENA & Training Provider)*

Position / Designation*

Contact No.*

E-mail Address*

TRAINING PROVIDER INFORMATION

Name of Training Provider*

Address of Training Centre*

SHENA ATP Registration Reference no.*

Date of Approval by SHENA*

TRAINER INFORMATION

Full Name	IC/ Passport No.	Upload IC/ Passport	Upload CV	Upload Employment Letter with the ATP/ Letter of Appointment (for part-time trainer)	Letter of agreement from invited trainer to conduct training at ATP (Optional)

Total no. of Trainers*

Important Notes

For each trainer, please include along the following:

Curriculum Vitae of the trainer including

The Academic Qualification
The Safety & Health Qualification
Teaching Qualification (i.e. Train the Trainer)
List and Duration of work experience
Contact Information
Photo in passport size

Copy of IC

For part time/ invited trainer, there should be:

Letter of appointment from the training provider for the trainer.
Letter of agreement from the invited trainer who agree to conduct the training course at your training provider.

TRAINING COURSE READINESS SUPPORTING DOCUMENTS

NOTE: You are required to combine all the documentation in 1 single PDF file as per the item above

Upload document(s)

Course lesson plan that shows the plan and time allocated for delivery of topics*

Complete full timetable of the course delivery*

Training lecture notes (to be compressed 6 slides in 1 page)*

Copy of Assessment used to deliver the training course (as per the course syllabus requirement)*

I declare that all particulars and information provided in this application and the documents attached hereto are true to the best of my knowledge and belief, and I understand that the Safety, Health and Environment National Authority (SHENA) reserves the right to reject this application if, at any stage, the information provided is false and incorrect. Should verification be required on any information provided in this application, I hereby authorise SHENA to carry out the necessary investigations.

Declaration of Applicant

I agree

Please check the box below to proceed