OCCUPATIONAL SAFETY PROFESSIONALS
BOARD
Web address: / APPLICATION FOR PROFESSIONAL REGISTRATION OF OCCUPATIONAL SAFETY PRACTITIONERS
New Application
Upgrade
Summary of Requirements for Professional Registration
ROSCord / Education: Grade 12+NQF Level 3 Qualification (ID 50062 or 77063) OR alternatively
a portfolio of short courses: See Page 2 of the Certification Procedure
Experience: 1 year* applicable experience (*2 years if only short courses offered as proof of education) / Industry Category Selected for Assessment:______
(See Note 2 on Page 3 in the Procedure Document)
FOR OFFICIAL USE ONLY: NOT TO BE COMPLETED BY THE
APPLICANT
Potential Category
ROSProfM + 4 + 5 Result ______
ROSPracM + 3 + 3 Result ______
ROSCord Grade 9 + 1 year experience
Evaluator ______Date______
ROSPrac / Education: Grade 12+ 3 years further study or 360 NQF credits in Occupational Safety and a written assessment based on a case study
OR alternatively
a portfolio of short courses: See Page 2 of the Certification Procedure
Experience:3 years* of experience in the functions described in the IOSM Unit Standards Register for Safety Practitioners (available at
(*5 years if only short courses offered as proof of education)
Candidates will be assessed for competence to practice by means of a written assessment.
ROSProf / Education: Grade 12 + Relevant NQF Level 8 Qualification or equivalent SAQA recognised international qualifications and a panel interview based on a case study. If the proof of the accreditation of the training is inadequate, a one-hour assessment plus the panel interview will have to be undertaken.
Experience: 5 years of experience in the functions as described in the IOSM Unit Standards Register for Safety Professionals(available at / APPLICANT’S PERSONAL DETAILS
Title ______
Surname ______
First Name/s ______
ID/Passport Number ______
Date of Birth ______
Home Contact Details (Use this as my Contact Address)
Postal Address ______City/Town______Postal Code ______Tel ______Fax______
E-mail______Cell ______
RTS October 2013 / Work Contact Details(Use this as my Contact Address)
(Name and address to appear on invoice)
Employer/Company name ______
PostalAddress______City/Town______Postal Code ______Tel ______Fax______
PROOF OF EDUCATION & TRAINING
(TERTIARY EDUCATION (beyond High School)
University/College/Institution / Course Title / Major
Subject/s / Full/
Part time / Duration / Course Accredited?
By? / Certified Copy of Certificate/
Diploma/Degree attached
PROOF OF EXPER / IENCE
Present Employer. ______Immediate Manager/Supervisor Name ______Contact No. ______
Date of employment from:______to:______(Provide Months & Years) Designation at Employment ______
Present Designation: ______Date appointed in present designation ______
Letter on official letterhead from Employer confirming details supplied on application form attached ______
Previous Employer 1.______Immediate Manager/Supervisor Name ______Contact No. ______
Date of employment from:______to:______(Provide Months & Years) Designation at Employment ______
Designation on Leaving: ______Date appointed in Designation held on leaving ______
Letter on official letterhead from Employer confirming details supplied on application form attached ______
Previous Employer 2.______Immediate Manager/Supervisor Name ______Contact No. ______
Date of employment from:______to:______(Provide Months & Years) Designation at Employment ______
Designation on Leaving: ______Date appointed in Designation held on leaving ______
Letter on official letterhead from Employer confirming details supplied on application form attached ______
Previous Employer 3.______Immediate Manager/Supervisor Name ______Contact No. ______
Date of employment from:______to:______(Provide Months & Years) Designation at Employment ______
Designation on Leaving: ______Date appointed in Designation held on leaving ______
Letter on official letterhead from Employer confirming details supplied on application form attached ______
ADDITIONAL DOCUMENTS
Current CV
Profile or Job Description of current position
Send the completed application form and supporting documents to: The Registrar, PO Box 14402 Clubview 0014
OR E-mail: AN INVOICE WILL BE PROVIDED ON RECEIPT OF THE APPLICATION
PLEASE NOTE: APPLICATIONS FOR REGISTRATION WILL NOT BE PROCESSED UNLESS ACCOMPANIED BY THE REQUIRED DOCUMENTED PROOFANDNO FAXED COPIES!!
I realise that for this application to be considered I must comply with the application requirements. I further understand that I will be subject to a written and/or oral assessment by IOSM Assessors. I agree to abide by IOSM’s decision as to my registration grade but realise that I do have the right to appeal such a decision.I agree to abide by the Constitution, Bylaws and Code of Ethics of IOSM. I certify that all information in this application is true.
Signature ______Date______