This Form Is to Notify Electranet of the Successful Completion of a Recognised Switching

\\\\ Document No.: 1-07-M01-F002

This form is to notify ElectraNet of the successful completion of a recognised Switching Training competency. It is important that each field of this form be completed and sent to . An original copy of this form must be retained by the forwarding company for compliance and audit purposes. Should you have any queries regarding the completion of this form or the status of your application, please do not hesitate to contact ElectraNet on 08 8404 7243.

APPLICANT DETAIL
Date: / Click here to enter a date. /
Surname: / Click here to enter text. / First Name: / Click here to enter text. /
Personal Email Address: / Click here to enter text. / Work Email Address: / Click here to enter text. /
Date of Birth: / Click here to enter a date. / Mobile No.: / Click here to enter text. /
Employer: / Click here to enter a date. / Department / Area of Employment: / Choose an item. /
Residential Address: / Click here to enter text. / Post Code: / Click here to enter text. /
Postal Address: / Click here to enter text. / Post Code: / Click here to enter text. /
USI No.: / Click here to enter text. / Skills Passport No.: / Click here to enter text. /
I consent to the collection and storage of my personal information and understand it will not be disclosed to any other organisation without my express permission.
Signature: / Click here to enter text. / Date: / Click here to enter a date. /
MANAGER VERFICATION AND APPROVAL
Name: / Click here to enter text. / Position / Title: / Click here to enter text. /
Email: / Click here to enter text. / Phone No.: / Click here to enter text. /
Applicants Switching Category: (if applicable) / Choose an item. / Licence Expiry Date: / Click here to enter text. /
Applicant Switching Operator Training Required: / ☐
New Licence Application / ☐
Licence Maintenance
Assessment / ☐
Reaccreditation
Confirmation of
Pre-requisites for Training: / ☐Trade Skilled Worker (Electrical or Power Line), or equivalent electrical qualifications
☐A restricted (Level 2) or higher, level of access accreditation
☐12 months of field experience associated with HV equipment or Transmission Lines
☐Rescue and Resuscitation accreditation
Signature: / Date: / Click here to enter a date. /
RTO CONFIRMATION OF SUCCESSFUL COMPLETIONOF TRAINING & ASSESSMENT
RTO: / Click here to enter text. / Assessment Date: / Click here to enter a date. /
Assessors Name: / Click here to enter text. / UOC Awarded:
(if applicable) / Click here to enter text. /
Licence Category Recommended: / Choose an item. / RPL Awarded
(yes/no): / Choose an item. /
Detail / Justification for RPL: / Click here to enter text.
Additional Comments: / Click here to enter text. /
Signature: / Click here to enter text. / Assessment Date: / Click here to enter a date. /
LICENCE ISSUE (ElectraNet use only)
Processed By: / Click here to enter text. / Date: / Click here to enter a date. /