APPLICATION FOR INCLUSION ON IHE REGISTER OF ROAD SAFETY AUDITORS

Please complete all sections in full

1. Surname / Family Name:

Forenames: Title: (Mr/Mrs/Ms/Miss):

Home address:

Postcode:

Email: Tel:

2. Employer:

Address:

Postcode:

Your Office Tel: Fax:

Office Email: Please use: my Home email Office email Both

3. Brief description of current role and responsibilities and length of time in that role: If applicable, please include any details of financial and resource management/responsibilities and any detail relating to roles involving Road Safety policy, procedures or strategies

Role Description / Length of time in role

4. Professional Institutions: List any memberships with dates of election. Please also provide details of any position you may hold within a Professional Institute, such as Branch Committee Member, or National Council Member

Institute / Date of Election / Grade

5. Educational Qualifications – (post school)

Qualifications Achieved / Dates / Where studied and where awarded / Certified by (awarding body)

6. Employment History

Please list brief details of employment history.

Employer / Dates / Job Title, description of your work

7. Continuing Professional Development (CPD)

Please provide details of a minimum of 2 days (or 12 hours total) CPD undertaken within the last 12 months focusing on Road Safety Audit, Collision Investigation and/or Road Safety Engineering. Details of further CPD can also be included if it covers other relevant areas such as highway design, traffic management and highway maintenance. Copies of Certificates of Attendance should be provided where provided. It should be noted that CPD does not have to take the form of formal training courses alone, outcome based structured reading, the preparation and presenting of relevant material and work based learning can all form part of a CPD record. Where structured reading is listed, this should be relevant to Road Safety Audit, Collision Investigation and/or Road Safety Engineering. The IHE Road Safety Review Panel may request a short report on lessons learnt when annual CPD solely achieved via structured reading.

CPD undertaken (including type of CPD) / Type of CPD / Duration / Dates / Provider/Organiser

8. Road Safety Training

Please list ALL relevant formal training in Collision Investigation, Road Safety Audit and Road Safety Engineering (minimum 10 days relevant formal training)

Course / Dates / Organiser/Location

9. Certificate of Competency in Road Safety Audit – Please state whether you have been awarded a Certificate of Competency in Road Safety Audit (in accordance with DMRB document HD19/15)

Yes/No / Awarding Training Provider/Body / Date

10. Road Safety Experience

Please describe in a 1000 words your Collision Investigation and Road Safety Engineering experience in reverse chronological order detailing a minimum of 5No schemes undertaken in the last 2 years and your involvement and responsibilities in each of those schemes.

11. Road Safety Audit Experience

Please describe ALL the Road Safety Audits you have been involved in, over the most recent 12 months.

Please Note: the previous 12 month period should be from the date of submission of this application.

Scheme description / Date / Role:
(Leader
Member/ Observer) / RSA Stage / Responsibility:
Author (A) or Checker (C)

Evidence: From the Road Safety Audit list above, please provide 5 previous finalised Road Safety Audit reports which you have been involved (if possible it is recommended that these demonstrate a range of differing stages within the design / construction process and scheme types) undertaken in the last 12 months as either a Road Safety Audit Team Leader or Road Safety Audit Team Member or Road Safety Audit Team Observer. Each Road Safety Audit with a minimum of 4 no. problems identified (In PDF format).

Note: The submitted Road Safety Audit Reports will be treated in confidence and only forwarded to the IHE reviewers related to this application. You may be required to seek client approval before providing copies of Road Safety Audit Reports to the IHE.

Evidence:

Road Safety Audits identified should be complete FINAL version documents; draft versions of Road Safety Audits are unlikely to be acceptable as part of this application.

Please ensure that you detail your role within the Road Safety Audit.

Applicants should be aware that the information provided must be sufficient for the IHE Road Safety Review Panel to assess their ability as a Road Safety Auditor.

The Road Safety Audit report submitted should be written, or have been checked/authorised by the applicant.

Please Note: It is not the responsibility of the IHE Road Safety Review Panel to read through various local procedures to clarify observed differences.

Where the Road Safety Audit report does not fully conform to HD 19/15 (for example where it is written to a local authority standard or other national procedure, please state within the description below how this procedure differs from HD 19/15, e.g. differences such as no Problem Location Plan required; no night-time site visit required for Stage 3 Road Safety Audit, observations and / or comments included within the Report). A request for further details of the alternative Road Safety Audit procedures used may be made by the IHE Road Safety Panel.

The IHE Road Safety Panel reserves the right to request additional examples of your Road Safety Audit work. Any additional examples requested will be drawn from the information you provide below.

12. For which level of registration are you applying? Please refer to IHE Register of Road Safety Auditors for level definition

Foundation Practitioner Lead Practitioner *

* Applicants for Lead Practitioner must additionally submit a 1000 word report demonstrating their relevant leadership, training and policy experience in the fields of road safety engineering and Road Safety Audit

13. Statement by Applicant

I declare the information in this application to be complete and correct.

Signed ………………………………………… Date …………………………………………….

14. Statement by Witness

Applications must be supported by an appropriate person vouching for the candidate’s submission. The witness should hold a recognised qualification in the field of Road Safety, civil engineering or Transport Planning or hold a senior position within a relevant company or organisation. The witness may be contacted by the IHE to verify the application.

I certify that all information given in this application is, to the best of my knowledge, complete and correct.

Name of Witness …………………………………………………………………………………..

Professional Grade/Institute ………… …………. Position……………………………………………..

Employer (name/address) ……………………………………………………………..

Phone No………………………………….. Email……………………………………..

Signed …………………………………………. Date …………………………………………….

IHE Membership Manager is the data controller for the personal data in this form for the purposes of the Data Protection Act 1998.

You have a right to a copy of the data held on you and to ask for any inaccuracies to be corrected.

INSTITUTE OF HIGHWAY ENGINEERS, Floors 32-34, 286 Euston Road, London, NW1 3DP

Tel: 020 3551 5681 Email:

Notes

Compliance with Requirements

Any applicant who does not achieve the requirements for registration will be informed in writing of the shortfall of their submission. Once a course of action has been identified and agreed, the additional 4 week period will be allowed to complete these actions.

Appeals

Any applicant who is not successful in their application is entitled to appeal against that decision.

Should the applicant wish to appeal against the decision of the IHE Road Safety Panel, the applicant should give written notice that they wish to appeal in accordance with the process detailed within the IHE Register of Road Safety Auditors Applications & Procedures. The applicant should clearly state the reasons as to why they feel that the decision warrants further consideration.

Annual Review

All registrants of the IHE Register of Road Safety Auditors will be reviewed by the IHE Road Safety Review Panel on an annual basis to ensure that all registrants are maintaining their necessary skills, training and experience relevant to Road Safety Audit, Road Safety Engineering and Collision Investigation.

Any new candidate who receives an award of registration within 100 days of the scheduled annual review process submission date, will not be required to submit an annual review for that particular year.

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