GUIDELINES ON THE RENEWAL OF COMPETENT PERSONS UNDER THE PROVISIONS OF

OCCUPATIONAL SAFETY AND HEALTH (THE CONTROL OF INDUSTRIAL MAJOR ACCIDENT

HAZARDS) REGULATION, 1996

Application must be address to :

Ketua Pengarah
Jabatan Keselamatan dan Kesihatan Pekerjaan Malaysia
Aras 2, 3 & 4, Blok D3, Parcel D,
Pusat Pentadbiran Kerajaan Persekutuan
62530 Putrajaya
(u/p : Pengarah Bahagian Major Hazard)
Website : http://www.dosh.gov.my

A person who wishes to be renewal Competent Person shall fill up this form and forward it together with :-

a) Application letter :

b) Expired Certificate :

c) Two (2) Passport sizes Photographs :

d) Photocopies of Course Training Certificate :

The applicant has to attend an interview conducted by the Department after his application has been
accepted.
 DEPARTMENT OF OCCUPATIONAL SAFETY AND HEALTH
OCCUPATIONAL SAFETY AND HEALTH (CONTROL OF INDUSTRIAL MAJOR ACCIDENT HAZARDS)
REGULATION 1996

APPLICATION FORM FOR REGISTRATION OF A COMPETENT PERSON

A. GENERAL PARTICULARS
Full Name (in block letters) : Date of Birth : Sex :
Male

Female

Citizenship :
NRIC Old :
Place of Birth
City :
New :

or Passport Number : State :

Country :

Home Address : Telephone Number :

Postcode :
Name of Organization and Address : Tel. No. :

Fax No. :

E-mail :

Postcode :
B. TRAINING COURSES (RELEVANT)
Name of Course or Seminar Date

C. LIST OF SAFETY REPORT OR EMERGENCY RESPONSE PLAN (LATEST)

Name of Company Type of Report Date of Prepared

E. Certification

I hereby certify the above information given is true and allow you or your representative to obtain information
related to this application from any relevant sources. If any information above is not true, you have the right
to reject the application or cancel my registration as competent person without any notice.

Signature : _______________________

Name : __________________________________________________ Date : ___________________