Fillable APPLICATION FOR INITIAL AUTHORISATION: CONTESTABLE WORK (Australian National University)

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APPLICATION FOR INITIAL AUTHORISATION: CONTESTABLE WORK (Australian National University)

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  • 51 check-boxes
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APPLICATION FOR INITIAL AUTHORISATION: CONTESTABLE WORK
CEOF6203 – JULY 2020 Issue 18 Ref. (CEOP8049) Page 1 of 4
Approved by: Manager Electrical Safety & Authorisation
COMMERCIAL-IN-CONFIDENCE UNCONTROLLED COPY IF PRINTED
SECTION A: APPLICANT DETAILS (personal contact details)
Name: Mobile:
Address: Town/Suburb: Post Code:
Date of birth:
Email address:
Applying for Authorisation as:
Level 1:
Class 1A – Overhead
Class 1B – Underground Paper/Lead & Polymeric
Class 1C – Underground Polymeric only
Class 1X
Apprentice – Cable Jointer
Apprentice – Electrician
Apprentice – Powerline Worker
Competent Assistant – Groundline
* Competent Assistant – Ladders
* Competent Assistant – EWP
Plant Operator
Telecommunication Worker – Groundline
Telecommunication Worker – Ladder
Telecommunication Worker – EWP
Level 2:
Class 2A – Disconnect and Reconnect
Class 2B – Work on Underground Conductors
Class 2C – Work on Overhead Service Conductors
Class 2D – Energising Service Equipment
Class 2X
Apprentice – Cable Jointer
Apprentice – Electrician
Apprentice – Powerline Worker
Competent Assistant – Groundline
* Competent Assistant – Ladders
* Competent Assistant – EWP
Telecommunication Worker – Groundline
Telecommunication Worker – Ladder
Telecommunication Worker – EWP
Note:
* Competent assistants are only authorised to act as rescuers for personnel working aloft on ladders or ladders and
EWPs, they are not authorised to work aloft.
Level 1 Network Induction Training
Preferred Date/Location:
.…... /….… /….… at ____________________
Access Permit Recipient Training (enrol via website)
Preferred Date/Location:
.…... /….… /….… at ____________________
Access Permit Recipient Transfer
Yes No
Expiry Date (as per existing card): _________________
Level 2 Network Induction Training
Preferred Date/Location:
.…... /….… /….… at _______________________
Are Sealing Pliers Required to be Issued
Yes
No (Pliers Id no:) ___________________
If no, specify existing Pliers Id no: ___________________
APPLICATION FOR INITIAL AUTHORISATION: CONTESTABLE WORK
CEOF6203 – JULY 2020 Issue 18 Ref. (CEOP8049) Page 2 of 4
Approved by: Manager Electrical Safety & Authorisation
COMMERCIAL-IN-CONFIDENCE UNCONTROLLED COPY IF PRINTED
SECTION B: APPLICANT DECLARATION
Have you had an accident or committed a safety breach in relation to work of an electrical nature within the last 2
years? Yes
No
If yes, please attach details on a separate report sheet.
I declare that I will:
• Work in accordance with Essential Energy’s Electricity Network Safety Management System and all other
relevant Operational Procedures, including the Electrical Safety Rules.
• Conduct hazard and risk assessments at all work sites and implement requirement controls where required.
• Report all accidents and incidents.
• Comply with Essential Energy’s Code of Conduct.
• Ensure that my annual refresher training is maintained.
• Return any authorisation identification card issued to me at Essential Energy’s request or when employment with
current employer ceases.
I further declare that the above information is true, correct, and current.
Name: Position Title:
Signature: Date:
SECTION C: ACCREDITED SERVICE PROVIDER DETAILS
Business Name:
ABN:
Postal Address:
Town/Suburb:
Post Code:
Nominated Contact Person:
Nominated contact phone number: Nominated contact email address:
Accreditation Details:
Level 1 ASP No:
Level 2 ASP No:
Expiry:
Grading:
Expiry:
Grading:
Level 1:
Class 1A – Overhead
Class 1B – Underground (Paper lead & Polymeric)
Class 1C – Underground (Polymeric ONLY)
Level 2:
Class 2A – Disconnection & Reconnection
Class 2B – Underground Service Lines
Class 2C – Overhead Service Lines
Class 2D – Energising Service Equipment
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APPLICATION FOR INITIAL AUTHORISATION: CONTESTABLE WORK
CEOF6203 – JULY 2020 Issue 18 Ref. (CEOP8049) Page 3 of 4
Approved by: Manager Electrical Safety & Authorisation
COMMERCIAL-IN-CONFIDENCE UNCONTROLLED COPY IF PRINTED
SECTION D: EMPLOYER ADVICE AND DECLARATION
Is the employer aware of and/or investigated whether the applicant has had an accident or committed a safety
breach in relation to work of an electrical nature within the last 2 years?
Yes
No
If yes
, please attach details on a separate report sheet.
On behalf of the accredited entity;
I accept that Essential Energy will invoice the accredited business for the initial authorisation fee ($541.21 (ex GST)) for
the above noted person and attest that the applicant is sufficiently competent to undertake the work for which he/she is
applying and agree to make this person aware of Essential Energy’s Electricity Network Safety Management System,
procedures, and any relevant Acts, Regulations, and Guidelines. I accept responsibility for work and actions taken by
the applicant whilst carrying out work on or near Essential Energy’s network whilst employed by the accredited body
nominated in this application.
I further declare that the above information is true, correct, an
d current.
Name: Position Title:
Signature: Date:
Completed
application, copies of supporting documents and id photo to be emailed to
authorisations@essentialenergy.com.au
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APPLICATION FOR INITIAL AUTHORISATION: CONTESTABLE WORK
CEOF6203 – JULY 2020 Issue 18 Ref. (CEOP8049) Page 4 of 4
Approved by: Manager Electrical Safety & Authorisation
COMMERCIAL-IN-CONFIDENCE UNCONTROLLED COPY IF PRINTED
This application form is for new applicants seeking initial level/s of authorisation, currently authorised
applicants adding a new level of authorisation or applying under an additional ASP, or returning
applicants seeking re-authorisation.
Authorisation for telecommunication classes, level 2X competent assistant, re-authorisation, if within
24 months of cancellation, and the addition of ASP’s to existing authorisation may not require
attendance at an induction and will not be charged the initial fee (renewal fee of $129.00 (ex GST) will
be charged).
The checklist below should be used to ensure correct completion of the application and that all
relevant supporting documentation accompanies each application.
Accompanying Checklist
Application for Authorisation: Contestable Work CEOF6203
1
Copy of the Letter of Accreditation from the Department of Planning & Environment
(stating business name, accreditation number, categories of accreditation, grading and
expiry date)
- Class 1
-
Class 2
2
Copy of your Employee Registration Letter from the Department of Planning &
Environment (stating applicants name, nominated distributor/s for authorisation &
categories for which they can seek authorisation)
- Class 1
-
Class 2
3
Copy of current training transcript/statement from a Registered Training Organisation (RTO)
for completion of Annual Regulatory Refresher Training (must show completion and/or
expiry date and units completed). (Please refer to skills and training matrix on the
Essential Energy website for current annual regulatory requirements). This should include
Essential Energy’s Electrical Safety Rules Training & Assessment
.
- Class 1
-
Class 2
4
Copy of Certificate III in Electrotechnology Electrician including transcript showing units
completed and Copy of Electrical Contractor and/or Qualified Supervisors Licence
-
Class 2D
5
Copy of Powerline Worker qualification including transcript showing units completed
(overhead applicants)
- Class 1
-
Class 2C
6
Copy of Cable Jointing qualification including transcript showing units completed
(underground applicants)
- Class 1
- Class 2B
7
Copy of Training Contract applicable to work being performed
Apprentices
- Class 1X
- Class 2X
8
Authorisation fee of $541.21 (ex GST): Please nominate your Essential Energy Sundry
Debtor Account number if one is already established and the fee will be invoiced to you. If
you do not have an account one will be established for you.
-
Class 1
-
Class 2
9
Security Deposit of $250.00 for issue of Essential Energy Sealing Pliers: Please nominate
your Essential Energy Sundry Debtor Account Number if one is already established and
the fee will be invoiced to you. If you do not have an account one will be established for
you.
-
Class 2
10
Provide a digital headshot against a plain coloured background and email in jpg format to
authorisations@essentialenergy.com.au
-
Class 1
- Class 2
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APPLICATION FOR INITIAL AUTHORISATION: CONTESTABLE WORK (Australian National University)

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Completed 2 May 2021

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