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IMCA Offshore Diving Supervisor Certification Scheme

Examination Application – Bell Diving Supervisor
This form must be completed in full by the sponsoring company (i.e. the candidate’s current or most recent employer), signed by
that company’s nominated authorised signatory and sent directly to the IMCA Certification Schemes Administrator. All specified
attachments must be enclosed with the form and it shall be understood that additional documentation may sometimes be
requested.
The current fee is £150 per compulsory module plus £25 per optional module.
Three passport-sized photographs of the applicant will be required before a certificate is issued.

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Applicant Details:
Surname:

.............................................................................................................................................................

Forename(s):

.............................................................................................................................................................

Address:

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.............................................................................................................................................................
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E-mail address:

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............................................................................................................................................... (optional)

Offshore Bell Diver Experience
Diver training certificate number:

................................................................................................................

Issuing authority:

................................................................................................................

Years experience:

...................................................................

Number of lockout hours:

...................................................................

Please attach a photocopy of the diver training certificate

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Trainee/Air Diving Supervisor Experience
IMCA/AODC Air Diving Supervisor certificate number (if applicable):

...................................................................

Please attach a photocopy of the IMCA/AODC certificate (if applicable)

Total number of offshore air dives supervised (if appropriate):

...................................................................

If the applicant is not a qualified IMCA/AODC Air Diving Supervisor:
Trainee Air Diving Supervisor course date:

................................................................................................................

Training course place:

................................................................................................................

Please attach a photocopy of the trainee air diving supervisor course completion certificate

Total number of offshore commercial air dives supervised:

...................................................................

Please attach photocopies of all letters of appointment.
Examination Application Form – Bell Diving Supervisor (updated December 2006)

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............................................................................. Address: ........................... ....................................................................................... I recommend that: .. confirming competence in accordance with IMCA guidance on competence assurance and assessment...............................................e.............................................................................................................................................. Examination Application Form – Bell Diving Supervisor (updated December 2006) Page 2 of 3 ............................................................................................ On the basis of satisfactory offshore reports......... Please attach a photocopy of the trainee bell diving supervisor course completion certificate Date of first appointment (following course): ............................. Date: ................................................................................................. (name) is a suitable candidate for Bell Diving Supervisor.............................. Signed: ...... If the date of first appointment is more than two years ago......................................................................................... Safety Manager or person of similar or higher standing within the company) I confirm that I have personally seen the applicant’s logbook(s) and the originals of the attached documents and that I can verify that the information set out above is correct.............................. Training course place: ............................................................. Number of bell runs supervised (since course): 5 ................................... Position: .... .. Company name and stamp: ........................................................ Name: ..... Supervised panel hours logged as Trainee Bell Diving Supervisor (since course): ............................................................................................................ or IMCA/AODC LST certificate number: ................. Please attach photocopies of all letters of appointment............................................................................................................................. Please attach a photocopy of the IMCA/AODC certificate (if applicable) 6 Optional Legislation Modules Applied For  7 British  Norwegian For completion by the company’s Nominated Authorised Signatory (i.............................. LST Experience Hours logged as an Assistant/LST: ...................................... Days worked as a Trainee Bell Diving Supervisor (since course): .............................................................................................................................................................................................................................................. please also attach copies of logbook entries for the past two years.............................................................4 Trainee Bell Diving Supervisor Experience Training course date: .........................................

AB51 0XA.Completed application forms should be submitted to: Mrs Vicki Graham. Aberdeenshire. Manurewa. Midmill. Certification Schemes Administrator IMCA. UK Examination Application Form – Bell Diving Supervisor (updated December 2006) Page 3 of 3 . Kintore.