THE COMPANY SAFETY RULES APPENDIX

1
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 Plant/Apparatus Area Authorisation

not foundName Category

Date .................... Signed ..............................

1
THE COMPANY SAFETY RULES APPENDIX
1
PART 2
APPOINTMENT OF PERSONS

REGISTER OF DEFINED PERSONS

FOR
SAFETY CONTROLLERS,
SAFETY CO-ORDINATORS AND SELECTED PERSONS

Error: Reference Plant/Apparatus Area Authorisation

source not foundNam Category
e

Date .................... Signed ..............................

2
THE COMPANY SAFETY RULES APPENDIX
2
AUTHORISATION FORM AND CERTIFICATE Ref No
(to be completed by the
Panel)

PART A 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 A B C D (see over)

Qualification Level: *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) Date ....

PART C CERTIFICATE OF AUTHORISATION

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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