DEPARTMENT OF OCCUPATIONAL SAFETY AND HEALTH Website : http://www.dosh.gov.

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CHECKLIST FOR RENEWAL OF REGISTRATION AS SAFETY AND HEALTH OFFICER (SHO)

Applications should be addressed to: Director General, Department of Occupational Safety and Health, Level 2, 3 & 4, Block D3, Complex D, Federal Government Administrative Centre, 62530 Federal Territory of Putrajaya. (ATT: Director of Industrial Safety Division)

Name of applicant : ________________________ Phone No Email : ________________________ : _________________________

The following information is required (information should be in the order below): NO. ITEM YES () NO (X) OFFICE USE

NOTE

1. 2. 3. 4.

A letter from the applicant's mailing address along with the latest along with phone numbers and email addresses. The original Certificate of Registration Book (Green Book). Copy of N.R.I.C. Renewal Application Form (Schedule II) properly filled. Two (2) recent driving license photographs (for the second Certificate of Registration Book (Green Book)) Please write your name, N.R.I.C. No. and SHO posts in the background. A processing fee of RM 50.00 in the form of: i. E-Payment Internet online RHB bank (please attach a copy of the payment receipt) ii. Cash only at JKKP Head Quarters iii. Money order / postal order / bank draft in the name of the Director General of DOSH MALAYSIA Letter of confirmation / support from employer confirming the applicant has served as a safety and health officer. Table points calculation system according to the Garis Panduan Sistem Mata Bagi Program Pendidikan Berterusan. (Attached with the copy of certificate of 'continuous education program' attended in the registration or renewal and related evidence)

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DEPARTMENT OF OCCUPATIONAL SAFETY AND HEALTH Website : http://www.dosh.gov.my Employer company profile contains information such as type of industry, number of employees, industry class under Rule Occupational Safety and Health (Safety and Health Officer) in 1997, and other information related Registration number of factory / workplace / construction site with Dosh and factory inspection reports / site construction / audit work (such as JKJ 17 or audit report from the State DOSH). The evidence or duties as a safety and health officer in accordance with Rules 18 and 19, of the Occupational Safety and Health (Safety and Health Officer) Regulations 1997 for the latest three months: i. Monthly report in summary form provided by Rule 19 (2); report shall be prepared and signed by the applicant and reviewed by the employer.

10.

11.

ii. Report audit / inspection work prepared by the applicant. iii. Minutes of meetings of the Health and Safety Committee prepared by the applicant that the applicant and the employer shall sign the minutes. iv. Accident Report, Health and Safety Program, Accident statistics and other related safety and health which is prepared by applicant.

NOTE: This checklist should be submitted with the application and read in conjunction with the Guidelines for Registration and Renewal Safety and Health Officer. For Office Use: DS 001 No. : Receipt No. : Registration No. : Receive Date : Office Stamp :i. Admin ___________________________________ ___________________________________ ___________________________________ ___________________________________ ii . Industrial Safety Division iii. PP Unit Head

For Officer Use (BKI): Receive Date Document Note : ________________________________ : Complete / Not Complete :

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SCHEDULE II

OCCUPATIONAL SAFETY AND HEALTH ACT 1994 OCCUPATIONAL SAFETY AND HEALTH (SAFETY AND HEALTH OFFICER) REGULATION 1997 RENEWAL OF REGISTRATION (Regulation 11) Expire Date 1.0 :

I .. N.R.I.C. No. . would like to apply for renewal of registration as a safety and health officer for the next three years. Attached herewith please find information on continuing safety and health education which I undertook for the last three years. Signature Name of applicant Registration No. : . : .. : Date:

2.0

Name & Address : .. of Employer ..... . . Phone No. (H) (O) (HP) Fax No. Email : . : . : . : .. :

Note: Please include money RM50.00 document processing fee in the form of: i. E-Payment Internet online RHB bank (please attach a copy of the payment receipt) ii. Cash only at JKKP Head Quarters iii. Money order / postal order / bank draft in the name of the Director General of DOSH MALAYSIA # Please make sure you have the MyKad identity card that has a logo on the back MyKad chip 64K for the purpose MyKad

OYK activation system to be implemented.