Personnel Information Sheet
Company DetailsCompany Name
Name
Address
Date of Birth
Existing Pegasus ID Number
Emergency Contact Information / Name:
Contact Number:
Primary Role or Function
Please refer to the Role Competency Matrix on page 3 to understand how your selection will impact the documentation you will need to provide prior to Induction.
Note: You can select more than one role.
□ / Supervisor / □ / Non-Construction Worker
□ / Other Trade Worker / □ / Non-Trade Worker
□ / Mechanical Engineer / □ / Mechanical Supervisor
□ / Qualified Mechanical Tradesperson / □ / Mechanical Worker (Non-Tradesperson)
□ / Electrical Engineer / □ / Electrical Supervisor
□ / Qualified Electrical Tradesperson / □ / Electrical Technician
□ / High Voltage Operator / □ / Maintenance Superintendent
□ / Client Staff or Representative (exists on MACH Energy organization chart)
While contracted to work at Mount Pleasant, will you be required to drive on site?
Yes □ No □
Acknowledgment
Must be signed by a Manager from the Contracting Company
I verify that this employee:
· Is competent to carry out the tasks assigned to him/her;
· Has been trained in all relevant safe work procedures; and
· Has been trained in the company’s WHS safety management system and is aware of their duties to comply with these requirements
Full Name ______ / Signature ______
Position ______ / Date ______
Email ______ / Contact Number ______
Client Approval
Must be signed by an authorised MACH Energy representative
Full Name ______ / Signature ______
Position ______ / Date ______
Contact Number ______ / Email ______
Individual Approval / Credit Card Details
Individual Registration, which includes all necessary inductions, will cost a total of $125.00 per person.
Please enter your credit card details below.
Credit Card Type
Visa □ MasterCard □
Credit Card Number
______-______-______-______ / CSC
______
Expiry Date
______-______ / Name on Card
______
Cardholder Name
______ / Cardholder Signature
______
For assistance, please contact Pegasus on 1300 365 747 or