AAM07 Accreditation Application form for Asset Access

This is a Forms Document and is best completed electronically, then printed. Completion of ALL fields is MANDATORY.

Please complete SECTION A of this form and submit to the training provider prior to attending the training course.

Completion of this form is NOT required for the online assessment

Company issuing license (Select only one) / SA Power Networks / ElectraNet
SECTION A
Applicant Contact Details
Name / Date of Birth
Position / Title / Employee No
Company Name / Section/Department
Company Address / (For SA Power Networks Staff please include DX No for return of license)
Company Phone / Mobile Phone
Company Email
Competencies / Skills Passport No
ENet Access Licence No / SA Power Networks Access Licence No
Completion of the following information is mandatory and required to verify the accreditation level applied for.
Attach additional documents to this form if required.
No included detail in this area will result in a Restricted Access (L1) license issue.
Continuation of Existing license / NOYes (If No then complete fields below)
Qualifications
Training
Has maintained continuous experience in the HV environment / YesNo
Years of experience
Type of equipment worked on
The level of supervision required or applied
Understanding and application of the requirements of the Asset Access Manual / YesNo
Any other relevant detail:
Manager’s Approval / I certify that subject to the successful completion of training, the applicant has the necessary skills, experience and ability to be issued the substation access license nominated.
Name / Date
Position / Title
Signature /
Company Address / (For SA Power Networks Staff please include DX No for return of license)
Company Phone / Mobile
What Accreditation Level is this application for? (Select ONE below)
Restricted Access / Unrestricted Access / Advanced Access (Inc Safety Observer & Authorised Recipient)
Application Type / 1st time Safety Observer / 15 hour log sheet attached
SECTION B
Training assessment and verification (competent or not yet competent)
Restricted/Unrestricted / CompetentNot yet competent / Advanced / CompetentNot yet competent
Restrictions / Comment
Trainer / Date
Company
Address
Phone / Mobile
Email
Signature /
SECTION C
Accreditation License issued (Asset Owner only)
Level / Level 1Level 2Level 3 Safety ObserverAuthorising Officer / Expiry Date
Name / Date
Position / Title
Signature /

Status: Issued Document Owner: Responsible Manager

Version: V1.8 Review Date July 2016