Middlemount Coal Site Induction Booking Request

Middlemount Coal Site Induction Booking Request
This Site Induction Electronic Booking Request Form is to be completed by the contractor company requesting the induction. Once approved, a pdf version of this document will be forwarded to you and is required to be submitted via the Contractor Portal for approval and final processing of the induction application. For support with the induction process, contact the Pegasus Middlemount Coal Compliance Team on 1300 306 384 or middlemountcoal@pegasus.net.au.
Administrative Contact Details
Name of person making this application*

First NameLast Name
Company*
As it appears in the Australian Business Register
Contact Email Address for correspondence about this application*
example@example.com
Contact Phone Number for further information about this application*

Area CodePhone Number
Candidate Details
Candidate Name*

First NameLast Name
Candidates Date of Birth*

DayMonthYear
Date
Candidates Email Address*
example@example.com
Candidates Phone Number*

Area CodePhone Number
Candidates Physical Address*

Street Address

Street Address Line 2

Suburb / TownState

Post Code
Next of Kin / Emergency Contact Name*

First NameLast Name
Next of Kin / Emergency Contact Phone Number*

Area CodePhone Number
Relationship*
ie partner, father etc
Candidate Job Scope
Please indicate who the candidate will be working for:*

Middlemount CoalMacKellar GroupMiddlemount Coal CHPPAusdrill
What will be the candidates job position/title whilst on site?*
Has the candidate previously completed a Middlemount Coal Induction?*

YesNo
Approximately when was the last time the candidate worked at Middlemount Coal?

DayMonthYear
Date
Documentation Requirements / Pre-Requisites
Original documents or certified true copies are to be uploaded into the Pegasus Contractor Portal when requested. The following is required as a minimum for enrolment into the site induction Standard 11 Statement of attainment (S11 Card alone is insufficient) Coal Board Medical (less than 5 years old - section 4.3 review date must not be expired) Current Drivers Licence / Proof of Identity Approved Site Induction Booking Request Form Resume New inductees are also required to supply a Drug & Alcohol Test that is no more than 14 days old from date of induction application.
I acknowledge
Minimum Site PPE Requirements
High Visibility Long Sleeve Shirt (Or reflective vest for non-high visibility clothing) Long Cotton Pants Lace Up Safety Boots with Metatarsal Protection (No elastic sided boots or external metatarsal guards) Hard Hat Safety Glasses
I acknowledge
Training Needs Analysis
Please tick the appropriate boxes specific to your job position requirements at Middlemount Coal in all four of the training needs analysis sections: Primary Role Authorisations Mobile Authorisations Appointments
Primary Role*

Management TeamAdministrative SupportTechnical SupportMining - OperationsMining - SupportMining - BlastingMining - DrillingMaintenance - Tradesman (Electrical)Maintenance - Support (Electrical)Maintenance - Tradesman - (Mechanical)Maintenance - Support (Mechanical)CHPP - OperationsCHPP - Operator / Maintainer (Electrical)CHPP - Operator / Maintainer (Mechanical)CHPP - SupportLaboratory - TechnicianIn Pit Delivery Driver
Authorisations*

SupervisorConduct Hot Work (Including Standby Person)Confined Space Entry (Including Standby Person)Working at Heights (Including Standby Person)Conduct Blast Guard DutiesConduct Drilling OperationsMobile Production Unit (MPU) OperationsOperate Class 3 LaserPhone / Camera UsageEquipment Compliance InspectorConduct Rigger ActivitiesConduct Dogman ActivitiesConduct Scaffolding ActivitiesOperate a ChainsawOperate an Elevated Work Platform (11m)Conduct Atmospheric MonitoringMobile Equipment ServicemanTest Operational Functions / Move and TestPoly WelderTyre FitterIsolation OfficerDynamic Brake TesterUAV Operations (Drone)Lighting Plant OperationsHV Switching OfficerHV Switching CoordinatorDrug & Alcohol TesterConveyor TechnicianContent Expert - Training SchemeScissor Lift OperatorCable Reeler OperationsBlasting & PaintingOperate a Bridge, Gantry or Overhead CraneNon-Slewing Crane OperationsSlewing Crane OperationsVehicle Loading Crane OperationsConduct Lifting OperationsConduct Conveyor OperationsConduct Crushing & Screening Plant OperationsMonitor Plant Operations for Coal PreparationPerform Control Room OperationsTreat & Dispose of Rejects & TailingsConduct Stockpile Reclaim OperationsConduct Rail Dispatch OperationsSafely Access the Rail CorridorNone of the above
Mobile Authorisations*

Light Vehicle OperationsRigid Haul Truck OperationsArticulated Haul Truck OperationsBulk Water Truck OperationsMedium Vehicle OperationsHeavy Rigid Vehicle OperationsMulti-Combination Vehicle OperationsHeavy Combination Vehicle OperationsHydraulic Excavator OperationsGrader OperationsWheel Loader OperationsTracked Dozer OperationsWheeled Dozer OperationsCoal Stockpile Dozer OperationsScraper OperationsBackhoe And Loader OperationsSkid Steer Loader Operations (Bobcat)Tractor OperationsVibrator Roller OperationsTelescopic Handler OperationsTyre Handler OperationsForklift OperationNone of the above
Appointments*

Site Senior ExecutiveTechnical Services ManagerMining ManagerElectrical Engineering Manager (EEM)Environment ManagerPlanning SuperintendentCoal Quality & Logistics SuperintendentGeological SuperintendentPit SuperintendentMaintenance & Contracts SuperintendentDrill & Blast SuperintendentHealth Safety / Training SpecialistAppointed Medical AdvisorOpen Cut ExaminerTrainer / AssessorMine SurveyorShotfirerAssistant ShotfirerSite Safety & Health Representative (SSHR)Electrical WorkerElectrical Safety ObserverHazardous Substance CoordinatorWork Permit Issuer – Working at HeightsWork Permit Issuer – Floor, Handrail, Protective StructureWork Permit Issuer – Confined Space EntryWork Permit Issuer – Hot WorkWork Permit Issuer – Excavation, Trenching, PenetrationWork Permit Issuer – Group IsolationWork Permit Issuer – Fire System ImpairmentWork Permit Holder – Working at HeightsWork Permit Holder – Floor, Handrail, Protective StructureWork Permit Holder – Confined Space EntryWork Permit Holder – Hot WorkWork Permit Holder – Excavation, Trenching, PenetrationWork Permit Holder – Group IsolationWork Permit Holder – Fire System ImpairmentRehabilitation RTW CoordinatorRespirable Dust SamplerContract OwnerRadiation Safety OfficerLaser Safety OfficerFire WardenEmergency Response TeamParamedicFitter & TurnerDiesel FitterAutomotive MechanicBoilermaking & Welding (1st Class Welding}Automotive ElectricianAutomotive Mechanical (Air Conditioning)Auto GlazierRefrigeration MechanicCarpenterPlumberNone of the above

Approvals
Approver Password
I have reviewed this application and

approve the candidate to attend a Middlemount Coal Site Induction on the dates above pending successful registration and document verification through the Pegasus portal.approve the candidate to be re-inducted pending successful registration and document verification through the Pegasus portal.reject the candidate
Authoriser
Date*

DayMonthYear
Date
Should be Empty: