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OE FINAL Feb2019

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Application for an Ontario Certificate of Qualification
as an Operating Engineer or Operator
Technical Standards and Safety Act
Technical Standards and Safety Authority
345 Carlingview Drive
Toronto, Ontario M9W 6N9
Tel: 416.734.3300
Fax: 416.231.4903
Customer Service: 1.877.682.8772
E-mail: certandexams@tssa.org
www.tssa.org
Operating Engineers Regulation
A. CERTIFICATION CANDIDATE INFORMATION:
Note: All information must reflect the information as written on your government issued photo identification.
TSSA must be notified of any change of address or contact information.
This form collects personal information for the purpose of administering certification and examination activities authorized by the
Technical Standards and Safety Act, 2000, S.O. 2000, c. 16.
B. I AM APPLYING FOR CERTIFICATION AS A(N):
C. APPROVED TRAINING COURSE:
To be completed by the signing authority of the Accredited TSSA Training Provider.
As the applicant submitting for certification, I certify that the information I have provided on this application, and all subsequent pages which relate to
my testimonial(s) of qualifying experience is true and correct. I understand that making a false statement may result in the revocation of authorization
and failure to provide the required information will result in delayed processing and/or approval of the request for certification.
OE 09032 (8/17) Page 1 of 3
Date
DD - MM - YYYY
Training Provider▼
Accreditation No.▼
Program Name ▼
Date Completed ▼
Address ▼
Phone No. ▼
Email Address▼
Name of Signing Authority* ▼
Signature of Signing Authority ▼
*As the signing authority for the TSSA Accredited Training Provider, I certify that the information provided related to the approved training course is
true and correct.
4
th
Class Operating Engineer
3
rd
Class Operating Engineer
2
nd
Class Operating Engineer
1
st
Class Operating Engineer
Refrigeration Operator Class A
Refrigeration Operator Class B
Compressor Operator
Steam Traction Operator
For Office Use Only
Date
Account No.
SR No.
Certificate No.
First Name▼
Middle Name▼
Last Name▼
Date of Birth▼
DD - MM - YYYY
Suite/Unit No.▼
Street No.▼
Street Name▼
City▼
Province▼
Postal Code▼
Primary Phone▼
Secondary Phone▼
Email▼
Current Certificate Classification▼
Current Certificate No. ▼
New Address or Contact Information?
Yes
No
▼
Clear Form
Print Form
Please print and sign before returning to TSSA
Please print and sign before returning to TSSA
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Application for an Ontario Certificate of Qualification
as an Operating Engineer or Operator
Technical Standards and Safety Act
Technical Standards and Safety Authority
345 Carlingview Drive
Toronto, Ontario M9W 6N9
Tel: 416.734.3300
Fax: 416.231.4903
Customer Service: 1.877.682.8772
E-mail: certandexams@tssa.org
www.tssa.org
Operating Engineers Regulation
D. TESTIMONIAL OF QUALIFYING EXPERIENCE:
To be completed by the Chief Operating Engineer/Operator or Company Official.
Note: If multiple plant locations, please complete and attach an additional Testimonial of Qualifying Experience.
CERTIFICATION CANDIDATE INFORMATION:
PLANT INFORMATION:
1
Where a company official has attested to the candidates qualifying experience, a letter of explanation (written on company letterhead,
signed by a company official) must accompany this application.
As the Chief Operating Engineer/Operator or Company Official, I certify that the information provided on the testimonial service relating to
operating and maintenance experience is true and correct.
OE 09032 (8/17) Page 2 of 3
Date
DD - MM - YYYY
R
EGISTERED
E
QUIPMENT
EXPERIENCE
PLANT CODE▼
REGISTERED KW POWER
RATING▼
EXPERIENCE TIME
OPERATING
MAINTENANCE
Months/Hours▼ Months/Hours▼
Boilers
Steam Prime Movers
Compressors
Refrigeration
Steam Traction
Hours▼
Hours▼
Boiler operations is mandatory for Operating Engineers and Steam Traction Operators.
All practical experience must be declared in months/hours, where one month means 160 hours, per O. Reg. 219/01.
Maintenance time must not exceed one third of the total time required.
Name of Signing Authority or Company
Official
1▼
Title of Signing Authority▼
Certificate No. ▼
Certificate
Classification▼
Phone No.▼
Company Name▼
Phone No.▼
Type of Plant ▼
Plant Name▼
Total Plant kW Rating▼
Plant Reg. No: ▼
R-
Plant Address▼
Operating Experience from▼
DD - MM - YYYY
Operating Experience to▼
DD - MM - YYYY
Total Qualifying Experience (No. of Months/Hours)▼
Position Held (Operating Engineer, Operator or Operating Assistant) ▼
First Name▼
Middle Name▼
Last Name▼
Please print and sign before returning to TSSA
Technical Standards and Safety Authority
345 Carlingview Drive
Toronto, Ontario M9W 6N9
Tel: 416.734.3300
Fax: 416.231.4903
Customer Service: 1.877.682.8772
E-mail: certandexams@tssa.org
www.tssa.org
Application for an Ontario Certificate of Qualification
as an Operating Engineer or Operator
Technical Standards and Safety Act
Operating Engineers Regulation
E. FEES & PAYMENT
The non-refundable certification application processing fee, as outlined in the Operating Engineers Fee Schedule, must be included for all applications.
Make cheque, money order, Visa or MasterCard payable to TSSA.
OE 09032 (8/17) Page 3 of 3
Technical
345 Carlingview Drive
COMPLETE FOR CREDIT CARD PAYMENTS
Standards and
Toronto, Ontario M9W 6N9
Safety Authority
Please print and fax back this completed form to Examination Services at 416.231.4903.
Charge my credit card:
VISA
MASTERCARD
Amount of Payment $
Card # Expiry Date
In payment of Client ID No.
Name of Card Holder Client Tel. No.
First Name Last Name
Signature of Card Holder
Date
dd-mm-yyyy
Month
Year
Please print and sign before returning to TSSA
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OE FINAL Feb2019

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Completed 19 July 2020

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