THE COMPANY SAFETY RULES

APPENDIX
PART 1

APPOINTMENT OF PERSONS
REGISTER OF DEFINED PERSONS
FOR
ISSUERS, ACCEPTORS AND DESIGNATED PERSONS
COMPANY: Error: Reference source not foundError: Reference source not found
Error: Reference source
not foundName

Date ....................

Plant/Apparatus Area

Authorisation
Category

Signed ..............................

THE COMPANY SAFETY RULES

1

APPENDIX
PART 2

APPOINTMENT OF PERSONS
REGISTER OF DEFINED PERSONS
FOR
SAFETY CONTROLLERS,
SAFETY CO-ORDINATORS AND SELECTED PERSONS

Error: Reference
source not foundNam
e

Plant/Apparatus Area

Date ....................

Authorisation
Category

Signed ..............................

THE COMPANY SAFETY RULES

APPENDIX

2
AUTHORISATION FORM AND CERTIFICATE

PART A

Ref No
(to be completed by the
Panel)

RECOMMENDATION FOR AUTHORISATION

I . Commissioning Manager of ...(Co./ Section) at .

confirm Name:..Designation.
..
Has been given instruction on the SZC Operational Safety Rules and Procedures and has
received appropriate practical training. I am satisfied that the person has the necessary
technical knowledge and experience and in my opinion, understands the responsibilities
of the Authorisation detailed below.
Signed..Dated.
*Authorisation Category
Qualification Level:

(see over)

*LV Apparatus (-up to 1000 volt) / HV Apparatus (-above 1000 volt)

*Code of Practice: TgBin-TTB-B0-HS-7800XX

(01,02,03,04,05,06,07,08,09,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,
33,34,35,36,37,38,39,40,41,42,43,44,45,46,47)

At .. (Site Location) on the following Plant and Apparatus

.....
....

PART B

AUTHORISATION PANEL

Authorisation Panel which consisted of

.. (Chairman) ... (Panel
member)
.. (Panel member) ... (Panel
member)

having examined the above named person is satisfied that he/she has the necessary
technical knowledge and experience to be appointed as defined in Part A above with the
following qualifications:
(if none write
None)
Signed ... (Chairman)

PART C

Date ....

CERTIFICATE OF AUTHORISATION
3

I certify that the above named person is Authorised in the categories and Groups as
indicated above.
Signed ... Date .
(SZC Manager)

PART D

RECEIPT OF CERTIFICATE OF AUTHORISATION

I acknowledge receipt of a copy of the Certificate of Authorisation and hereby declare that
I have read and understand the SZC Operational Safety Rules and Procedures and agree
to act in the capacity defined.
Name .... Signed .... Date ..
.
*Delete where not
applicable