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HSE OFFICER APPROVAL APPLICATION
ZA-DC-F-34 Issue 7, Rev 0, Dated 22/11/2017 Page 1 of 2
For New Registration:Below documents to be scanned in colorand submitted in a CD
1. Copy of passport with valid visa page2. Passport-size photograph3. Detailed CV4. Copy of attested educational certificates5. Copy of experience certificate(s)6. Copy of HSE qualification certificates
For Renewal:1. Copy of passport with valid visa page
For Employer Change: 1. Copy of passport with valid visa page2. Existing registration card (if not expired)
For Upgrade Position:1. Copy of passport with valid visa page2. Existing registration card (if not expired)
For Replacement of Lost / Damaged Card: NA
For Linking/Delinking Plots:1. Link Delink2. If Link, Plot No(s). to be linked:
If Delink, Plot No(s). to be delinked: For HSE Officer App Username Change:1. Copy of passport with valid visa page (if not submitted previously)2. Existing username (e-mail address)
New username (e-mail address)
HSE OFFICER’S ID NO# (if any) PLOT NO.
CONTRACTOR NAME
SUBMISSION TYPE
New Registration RenewalEmployer Change Upgrade Position
Replacement Of Lost/Damaged Card Linking/ Delinking PlotsHSE Officer App Username Change
DOCUMENTS REQUIRED
SR. NAME OF INSTITUTION LOCATION COURSEPERIOD
FROM TO
QUALIFICATIONS:
ZA-DC-F-34 Issue 7, Rev 0, Dated 22/11/2017 Page 2 of 2
SR. NAME OF INSTITUTION LOCATION POSITIONPERIOD
FROM TO
EXPERIENCE:
Note: DCCA Zoning Division shall bear no liability in registration of “HSE Officer” for genuinity of the attested educational certificates. Requestor (HSE Officer) shall bear the full liability incase of forged educational certificates
NAME
MOBILE
DATE
SIGNATURE
STAMP
HSE OFFICER DETAILS
NAME
MOBILE
DATE
SIGNATURE
STAMP
CONTRACTOR DETAILS