Form N

For Official
PERSONAL DETAILS
Use only
Title: Mr. Ms. Mrs. Address:
First Name: FAIZAL 15th street Rumeilah
Hili District
Last Name: SHARAFUDHEEN Villa No : 6
Telephone No: 02-6431828 City: Al Ain
Mobile No.: 0528234414 P.O. Box: 84174
E-mail Address: faizalps@ablem.ae Emirate: Abu Dhabi

ACADEMIC BACKGROUND
Please list only achieved degrees and diplomas. You may add more rows for qualifications, if For Official
needed. Use only
Year Year Year
No. Degree | Diploma | Major(s)
Started Ended Issued
1 Bachelor of Technology in Electrical & Electronics Engineering 2008 2011 2011
2 Diploma in Electrical Engineering 2005 2008 2008
3

International OHS Membership / Registration

Please list only valid memberships / registration. You may add more rows, if needed. For Official
Use only
No. Membership / Registration Issue Date Expiry Date

1
2
3

PROFESSIONAL TRAINING ATTENDED.

You may add more rows for training, if needed.
For Official
Course Date of Certificate Use only
Duration Dates
No. Name of Training Course Training Provider Expiry
of Course (DD/MM/Y Issue (if
YYY) applicable)

Abu Dhabi Occupational Safety & 01-05-17

1 Health Practitioner Course ADVETI 2 days to 23-05-17
(mandatory) 02-05-17
10-03-17
CHICAGO Training
2 Occupational Health & Safety 80 Hours to 26-05-17
& consultancy
26-05-17
Emirates Technical
3 Basic Fire Fighting & Safety One day 12-02-17 12-02-17 11-02-20
development Centre
4 Basic First Aid Emirates Technical One day 12-02-17 12-02-17 11-02-20
& Safety

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development Centre
CHICAGO Training
5 Risk Assesment
& consultancy
Diploma MEP Taiba Engineering One
6 28-06-14
Electrical & Fire Fighting Consultants, INDIA month

Certificate of completion-
7 PPE for safe climbing & Working CAMP Safety One day 06-03-17 09-03-17 08-03-19
at height on pylons

OSH & OSHMS RELATED WORK EXPERIENCE

Please list all Occupational Safety & Health (OSH) and / or Occupational Safety & Health For Official
Management System (OSHMS) related work experience (attach Service Certificates). You may add Use only
more rows for Positions, if needed.
Position 1:
Company Name:
Date Started:
Date Ended:
Job Responsibilities:
Major Tasks
Completed

Position 2:
Company Name:
Date Started:
Date Ended:
Job Responsibilities:
Major Tasks
Completed

Position 3:
Company Name:
Date Started:
Date Ended:
Job Responsibilities:
Major Tasks
Completed

TOTAL OSH & OSHMS RELATED WORK EXPERIENCE

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 Form N

For Official
Please do not ADD any rows below this line.
Use only
Total number of years of experience in OSH field:
Total number of years of experience in the supervisory roles in OSH field:
Number of days worked in OSHMS Development and / or Implementation Project:

OSH & OSHMS RELATED PROJECT EXPERIENCE (WHERE APPLICABLE)

For Official
Please provide details of OSH related projects you worked on while holding the above Use only
MENTIONED position You may add more rows for Projects, if needed
Project # 1
Description:
Role in the Project:
Project Start Date:
Project End Date:
Client Reference:
Client Reference
contact phone:
Client Reference
email:

Project # 2
Description:
Role in the Project:
Project Start Date:
Project End Date:
Client Reference:
Client Reference
contact phone:
Client Reference
email:

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 Form N

OSH & OSHMS TRAINING DELIVERY EXPERIENCE (WHERE APPLICABLE)

For Official
Please list all Occupational Safety & Health (OSH) and / or Occupational Safety & Health Use only
Management System (OSHMS) training delivery experience. You may add more rows if needed.
Course Title:
Client Organization /
Group:
Course Duration in Hours:
Day/s spent for course
preparation (1 day=8hours):
Number of times this
course was delivered:

Client Reference:

Client Reference contact

phone and email:
Brief overview of the
Training Course:

Course Title:
Client Organization /
Group:
Course Duration in Hours:
Day/s spent for course
preparation (1 day=8hours):
Number of times this
course was delivered:
Client Reference:
Client Reference contact
phone and email:
Brief overview of the
Training Course:

OSHAD SF Forms
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 Form N

OSHAD SF Forms
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