About usSite mapFAQContact us

SEARCH:
Personal details - For the purpose of enrolment Workplace Health and Safety requires that you provide the following details for recordkeeping requirements.
* 
Title:
  
* 
Family name:
  
* 
Given names:
  
* 
Date of Birth:
  
* 
Street address:
  
* 
Suburb:
  
* 
City/Town:
  
* 
State/Province:
  
* 
Country/Region:
  
* 
Post/Zip Code:
  
* 
Telephone (including Country and Area Code e.g. 61-2 Australia, Sydney):
  
 
Facsimile (including Country and Area Code e.g. 61-2 Australia, Sydney):
  
 
Mobile phone number:
  
* 
Email Address:
  
Employer details - Provide the following details in relation to your employer where you are currently employed.
* 
Employer (Where you not employed place 'Not employed' in the field:
  
 
Street address:
  
 
Suburb:
  
 
City/Town:
  
 
State/Province:
  
 
Country/Region:
  
 
Post/Zip Code:
  
 
Telephone (including Country and Area Code e.g. 61-2 Australia, Sydney):
  
 
Facsimile (including Country and Area Code e.g. 61-2 Australia, Sydney):
  
* 
Email Address:
  
Employment - Of the following, select ONE which BEST describes your current employment status?
 
Full time employee:
                
Employed - Unpaid family worker:
  
 
Part time employee:
                
Unemployed - Seeking full time work:
  
 
Self-employed - Not employing others:
                
Unemployed - Seeking part time work:
  
 
Employer:
                
Not employed - Not seeking employment:
  
Schooling.
* 
Are you still attending secondary school?
  
Yes

No

* 
What is your highest COMPLETED school level?
  
Year 12

Year 11

Year 10

Year 9 or lower

* 
In which YEAR did you complete that school level?
  
Prior educational achievements.
* 
Since leaving school, have you completed any qualifications?
  
Yes

No
Where you have attained additional qualifications indicate the qualifications that you hold.
 
Trade Certificate:
                
Undergraduate Degree:
  
 
Advanced/Technician Certificate:
                
Degree or Postgraduate Diploma:
  
 
Associate Diploma:
                
Unspecified Prior Educational Achievement:
  
 
Other Certificate:
  
Place of Birth.
* 
Were you born in Australia?
  
Yes

No

 
If NO, then in which country were you born?
  
* 
Are you of Aboriginal and/or Torres Strait Islander Origin?
  
Yes

No
Language.
* 
Which language do you mainly speak at home?
  
English

Other

 
If OTHER, please specify the language spoken
  
Medical Condition/Disability.
* 
Do you consider yourself to have a permanent and significant disability?
  
Yes

No
If YES, indicate the nature of the medical condition/disability.
 
Visual/Sight/Seeing:
                
Intellectual:
                
Hearing:
  
 
Chronic Illness:
                
Physical:
                
Other:
  
Course Enrolment Details.
* 
Course in Functioning as a Workplace Health and Safety Representative:
  
* 
Course / Training Package Code:
  
* 
Commencing or continuing course:
  
Modules / Competencies enrolled. (Indicate the modules that you are enrolling for)
 
WHSR01B Identify and apply relevant workplace health and safety information.
  
 
WHSR02B Identify hazards and control risks in the workplace.
  
 
WHSR03B Represent workers in workplace health and safety consultation mechanisms.
  
 
WHSR04A Issuing workplace health and safety provisional improvement notices.
  
* 
I believe that the information which I have provided and/or made in the completion of this Enrolment Application to be true, factual and correct in every particular.
  
* 
Full name:
  
* 
Date of application:
  

Workplace Health and Safety Representative Training Course
  Login  |  Site Credits