Muswellbrook Coal Rehabilitation Induction & Authorisation Request Form

Muswellbrook Coal Rehabilitation Induction & Authorisation Request Form
Company Details
Company / Employer*
Company Contact*

First NameLast Name
Company Contact Email*
Approval/Rejection will be sent to this email address
Company Contact Phone Number*

Area CodePhone Number
Worker Details
*

New Pegasus RegistrationPegasus ID
Pegasus ID*
Full Name*

First NameLast Name
Date of Birth*

DayMonthYear
Email*
example@example.com
Phone Number*

Area CodePhone Number
Vehicle Registration Number*
Work Details
Workers Job Title*
Select 1 or more Job Title for role requirements in which area will this worker be working*

Thiess Sub Contractor (Mining & General)Thiess Sub Contractor (Maintenance & High Risk Works)
Requested Induction Date*

MonthDayYear
Minimum Induction Requirements (please acknowledge these requirements by ticking in the checkboxes)*

State Drivers LicenceOrder 43 MedicalRole Qualification(s)Letter of Competency (Employer Issued)Appointment Request*
*Mechanical and Electrical roles require separate appointment - refer to MPO Maintenance Skills Matrix for appointment /authorisation requirements
Competencies / Skills / Tasks / Activities to be conducted on site Please detail competencies / skills / tasks / activities to be conducted on site by the Inductee - evidence of training and experience must be provided with all evidence current and legible
Will you be performing Electrical and/or Mechanical work on-site? *
International Trade Recognition
Work to be Performed*
Work Start Date*

DayMonthYear
Please ensure the relevant Appointment form(s) is submitted with your induction request. Mechanical Appointment Letter Electrical Appointment Letter
Thiess Muswellbrook Coal Rehabilitation Approver Password
Site Access Pre-Approval Sign-Off*

Approve the candidate to attend the Muswellbrook Coal Rehabilitation InductionReject the candidate
Authoriser*
Date*

DayMonthYear
Date
Should be Empty:

Muswellbrook Coal Rehabilitation Induction & Authorisation Request Form

Company Details

Worker Details

Work Details