Power Training Services WA Enrolment Form

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Buddy Payne
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1 Power Training Services WA Enrolment Form Course Enrolment and Prerequisites You are required to provide evidence of the prerequisites listed on the course descriptor to Power Training Services WA (PTSWA) prior to your enrolment being accepted and confirmed. Please attach and return your evidence with this enrolment form to PTSWA as soon as possible: By to or By hand, or post to 90 Training Place, Jandakot, WA 6164 Please note: All prerequisites must be current and certified; a list of who can certify a document can be viewed here Where training has been completed at PTSWA please tick to indicate; this will be verified by PTSWA Where indicated (*) evidence of superseded and equivalent units may be provided Please contact PTSWA on (08) if you have any questions about your prerequisite evidence. Please ensure that your formal leader or manager completes the declaration included in the prerequisite section of this application. Course/s being applied for Maintain energised HV distribution overhead electrical apparatus (stick) (UETTDRDP13A) Maintain energised HV distribution overhead electrical apparatus (glove) (UETTDRDP14A) Student Details Unique Student Identifier (USI) If you do not have a USI you can apply for one at: Note: You do not need to supply your USI if you have already provided this to us. Western Power Network Authority Number (NAC) Family Name Given Names Title Mr Mrs Ms Miss Dr Other please specify

2 Gender Male Female Date of Birth Street Address State Postcode Postal Address (if different from above) State Postcode Contact Details Employer Details Emergency Contact Medical Conditions Do you have any medical conditions that we need to be aware of? Work Phone Mobile Phone address Employer Name Employer Contact Name Employer Contact Number Name Relationship Contact Number Yes No If you have answered Yes please provide details if you think this will impact on your training. LLN Assistance Do you require assistance with Language, Literacy or Numeracy? Yes No

3 Student Consent I hereby consent to my personal information (including my PTSWA training records) being disclosed by PTSWA to directors, officers and employees and agents of Western Power and/or third parties under or in connection with one or more of the following circumstances: For the purposes of Western Power performing an incident investigation involving me To provide information to Western Power Network Authorisations to enable authorisation to work on the Western Power network To provide information to other RTOs or training providers for the purpose of proving that prerequisites have been met prior to attending a course with another RTO or training provider To provide non-identifiable statistical data to government entities I also consent to my employer (where they are not Western Power) and where they are paying for my training to be given access to my training information. Date Signature

4 Prerequisite Evidence Please tick what you are providing as evidence and how this is being provided Document PTSWA Training Record Copy of current NAC Certified copy of UET Certificate III in ESI distribution overhead (including Record of Results) Certified copy of Statement of Attainment for: UETTDRRF08B Perform EWP controlled descent escape UETTDRRF02B Perform pole top rescue BSBLDR403 Lead team effectiveness, or superseded unit BSBWOR402A Promote team effectiveness*** TLILIC2005 Licence to operate a boom-type elevating work platform (boom length 11 metres or more)** ** Certified copy of high risk licence may be provided *** Western Power personnel only if unit is not held and enrolment is required please complete and return the Learning and Development request form provided on the next page Declaration by formal leader/manager I confirm that the student named in this application has met the following selection criteria requirements for live work training as per section 3.1 of the Western Power High Voltage Live Work manual: Formal interview Medical examination Safety attribute evaluation In accordance with the listed requirements a copy of all items has been retained on the student s personnel file. Name Position/Company Date Signature

5 Learning and Development Request Please ensure all mandatory fields (denoted *) are completed to prevent the form being sent back to the requestor. Requestor Details Name: * Position: * Function: * Area: * Location: * Telephone: * * Key Information Number of employees who require development: * Please list name(s) of employees who require development (if known) (Please attach as separate sheet if over 10 employees) Targeted roles who require development: * e.g. Engineers, Administration Date Required by: * (DD/MM/YYYY) Do you expect this to be an ongoing requirement for your employees? * Yes No If required, how long can the employee be released for to attend off the job training? Are there any key software, systems or equipment required for this development to occur?

6 Please provide as much information as possible to help us understand your specific requirements. Learning and Development Requirements: Provide a brief summary / overview of the learning and development requirements, including the reason / motivation for the request and what has already been done to address the issue. If completing this request as an individual has the development need been recorded in your STRIVE review? * Is this a request for your current role or future role? * Yes Current No Future How does this request align to achieving business goals and objectives? Learning and Development outcomes required Describe the impact on business objectives (Strategic Plan), specific qualifications, skills and knowledge, specific tasks, duties or procedures that you wish to address / achieve: Business Unit Information Budgetary approval in place? Yes No Budget available ($) $ DFA approver name: * DFA approver sign off: * Yes No Date: * Your request will be submitted to the Western Power Learning and Development team who will contact you regarding enrolment in the requested training.

VOLUNTARY UP-SKILLING PROGRAM ENROLMENT FORM ABN: RTO Code: 52221

VOLUNTARY UP-SKILLING PROGRAM ENROLMENT FORM ABN: RTO Code: 52221 1. THIS FORM IS A VOLUNTARY UPSKILLING You have entered into an agreement to participate in voluntary upskilling program. This program s training and assessment is aligned to nationally recognised units