Millennium Mine Site Induction Booking Request

Millennium Mine 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 Peabody Compliance Team on1300 365 747 or peabodycompliance@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
Candidate Job Scope
What will be the candidates job position/title whilst on site*
Has the candidate previously completed a Millennium Mine Induction*

YesNo
Approximately when was the last time the candidate worked at Millennium Mine?

DayMonthYear
Date
Documentation Requirements / Pre-Requisites
Original documents or certified true copies are to be uploaded into the Pegasus Contractor Portal when requesting. 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) Current Drivers Licence / Proof of Identity Approved Site Induction Booking Request Form New inductees are also required to supply a Drug & Alcohol Test that is no more than 7 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 Millennium Mine in all three of the training needs analysis sections: Primary Role Authorisations Appointments
Primary Role*

Administrative SupportCrane OperatorDogmanHighwall Mining OperatorLabourerManagement TeamMining Operator (Surface)Maintenance Trades - ElectricalMaintenance Trades - MechanicalOpen Cut ExaminerTechnical Support
Authorisations*

Bobcat OperatorBrake TesterCable Reeler OperatorConduct Atmospheric MonitoringConduct Hot WorkConduct Lifting OperationsContent ExpertDozer OperatorDrug AnalystElevated Work Platform (11 Metres)Excavator OperatorForklift OperatorFront End Loader OperatorGrader OperatorGroup IsolatorHaul Truck OperatorHeavy Rigid Vehicle OperatorHighwall Miner - Provide Deck SupportHighwall Miner OperatorHighwall Mining SupervisorHV SwitchingLight Vehicle OperatorLighting PlantManitou - TelehandlerMedium Rigid Vehicle OperatorNon-Slew Crane OperatorOperate ChainsawOverhead Gantry Crane OperatorPermit IssuerPolywelderRigger / DogmanScaffolderScissor Lift OperatorScraper OperatorService Truck OperatorSlew Crane OperatorSupervisorTractor OperatorTyre FitterUse CameraUse of Mobile PhoneVehicle Loading Crane OperatorWater Truck OperatorWork at HeightsWork in Confined SpaceNone of the Above
Appointments*

Electrical Engineering Manager (EEM)Electrical Worker (General)Electrical Worker (Highwall Mining)Emergency Response Team MemberHazardous Substance CoordMechanical TradespersonMine SurveyorOpen Cut Examiner (OCE)Senior Person (Sec 55)Site Senior Executive (SSE)Site Senior Executive (SSE) DelegateTrainer AssessorNone of the Above

Approvals
Approver Password
I have reviewed this application and

approve the candidate to attend a Millennium 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*

MonthDayYear
Date
Should be Empty: