SISHEN MINE

REV IMPLEMENTATION DATE 2016-01-01

AUTHORISATION TO WORK ON HEIGHTS 00 DOC NO SHEQ-ENG-FORM-056

AUTHORISATION TO WORK ON HEIGHTS

Name: Employee number:

Division: Section:

New Learners Previous Certified Licence type (Code):

COMPETENCY CERTIFICATE
The above-mentioned person has completed training and has been proven competent by testing to use the
under-mentioned equipment effectively and safely.
Course
Description Of Unit Standard Date Date
Code/Unit NQF LEVEL Examined
Title/Training Course Started Expired
standard
Explain And Perform Fall Arrest
Techniques When Working At 229998 NQF LEVEL 1
Heights

AUTHORISATION
In terms of MINE HEALTH AND SAFETY ACT, 1996 you are hereby authorised from date of this letter to use the
above-mentioned equipment, in accordance with the requirements as laid down by the MINE HEALTH AND
SAFETY ACT, 1996. This authorisation replaces all previous authorisations granted in this respect.

Signature
Designation Date
Engineer
I hereby accept the appointment for the driving of the above-mentioned lifting equipment under MINE HEALTH
AND SAFETY ACT, 1996

Signature Designation Date

Learner

OFFICAL USE ONLY

SIGNATURE AND EMPLOYEE
AUTHORISATIONS NAME POSITION DATE
NUMBER
AUTHOR M BESTER SENIOR MECHANICAL ENGINEER SIGNED BY 1911114 30 SEPTEMBER 2015
REVIEWED BY D ROUX ENGINEERING PRINCIPAL SIGNED BY 1912139 30 SEPTEMBER 2015
APPROVED BY E STONESTREET MANAGER ENGINEERING SIGNED BY 2002609 30 SEPTEMBER 2015

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