SHENA - Training Provider Form

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Application to act as an Approved Training Provider

TYPE OF APPLICATION

Type of Application*

New Application* Renewal*

APPLICATION BASIC INFORMATION

This will be the focal person for any matters related to approval to act as a Training Provider

Applicant's Name (Focal Point between SHENA & Training Provider)*

Contact No.*

Email Address

TRAINING PROVIDER BASIC INFORMATION

Name of Company (As per the Company Registration Letter/ Certificate)

Company Registered / Mailing Address*

Location Address of Training Provider (for theory session)*

Location Address of Training Provider (for practical session)*

Company Official Contact No.*

Company Official Email Address*

Managing Director Details

Name of Managing Director / CEO*

Contact No.*

TRAINING PREMISES & FACILITIES INFORMATION

Does the training provider have a permanent or rented location to provide the training?

No Yes

B) If Yes, Please upload your training facilities and equipment

Company Organization Chart*

Company Registration Certificate*

Copies of Letter of Appointment for Full Time Staff*

Training Provider Occupational Safety & Health Policy*

C) If No, please describe how your training provider will deliver the training?*

Upload any agreement letter to support the use of facilities as mentioned

LIST OF TRAINING COURSE(S) OFFERED

Name of Training Course	Type of Course (Awareness or Competency)	Standard Followed (if any)	Mode of Delivery (Theory/Practical/Both)	Duration (No of Days)	Medium of Instruction (Language)	Accreditation or Certifications (if any)	Maximum no. of participants per course	Upload Course Information & Objectives	Upload Course Lesson Plan/ Timetable/ Schedule of Course Delivery	Upload Lecture Notes/ Course Materials used to deliver the course note: if it is using Powerpoint Slides, please arrange 6 slides in 1 page to reduce size of the uploaded file.	Upload Assessment used for this course

DETAILS OF TRAINER

Full Name	Passport / Identity Card No. (Colour)	Date of Birth	Highest Academic Qualification	Assessing Qualification (i.e. Train the Trainer Certificate)	Mode of employment with your training provider	Upload copy of employment letter (for full time trainer)	Letter of appointment from the training provider for the trainer (for part time trainer)	Letter of agreement from the invited trainer who agree to conduct the training course at your training provider (for part time trainer)	No. of Years & Months of Working Experience (in total) Grid	No. of Years & Months working in Health & Safety Profession (if any) Grid	Upload CV	Upload Certificate (Please compile all the relevant certificates in 1 single PDF file)

Upload CV*

Upload Certificates*

DETAILS OF ASSESSOR

Full Name	Passport / Identity Card No. (Colour)	Date of Birth	Highest Academic Qualification	Assessing Qualification (i.e. Train the Trainer Cert)	Mode of employment with your training provider	No. of Years & Months of Working Experience (in total) Grid	No. of Years & Months working in health & Safety Profession (if any) Grid	Upload CV	Upload Certificate (Please compile all the relevant certificates in 1 single PDF file)

Upload CV*

Upload Certificates*

DETAILS OF VERIFIER

Full Name	Passport / Identity Card No. (Colour)	Date of Birth	Highest Academic Qualification	Assessing Qualification (i.e. Train the Trainer Cert)	Mode of employment with your training provider	No. of Years & Months of Working Experience (in total) Grid	No. of Years & Months working in health & Safety Profession (if any) Grid

Upload CV*

Upload Certificates*

SUPPORTING DOCUMENTS

Note: Please compile the documentation/ photographs/ certifications in 1 single PDF file for each category listed below

A. BUSINESS PROFILE

Training Provider Organisational Chart*

Company Registration Certificates*

Copies of Letter of Appointment for Full Time Staff*

Training Provider Occupational Safety & Health Policy*

B. EVALUATION & CERTIFICATE

Copy of Course Evaluation Form / Feedback Form for Candidates*

Sample Copy of Certificate Awarded to Successful Candidates*

Guidelines / Process of Giving Out Certificates*

C. EMERGENCY PROCEDURES (for training provider with permanent/ rented premise)

Emergency Evacuation Layout Plan

Documented Procedure in the event of emergency*

Photographs of Emergency Equipment (e.g. Fire Extinguisher [with inspection tag], Fire Alarm, Fire Hose Reel [if applicable], First Aid Box, etc.)*

List of Fire Marshal / First Aider (with certificates)*

Insurance Cover (for premises)*

Copy of Training Provider’s Safety & Health Induction to participants*

I, declare that all particulars and information provided in this application and the documents attached hereto are true to the best of my knowledge and belief, and I understand that the Safety, Health and Environment National Authority (SHENA) reserves the right to reject this application if, at any stage, the information provided is false and incorrect. Should verification be required on any information provided in this application, I hereby authorise SHENA to carry out the necessary investigations.

Declaration of Applicant

I agree

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