Registration Form For Renewal of Safety and Health Officer (SHO)

Topics: Occupational safety and health, Occupational health psychology, Money order Pages: 7 (658 words) Published: November 3, 2013
DEPARTMENT OF OCCUPATIONAL SAFETY AND HEALTH
Website : http://www.dosh.gov.my

CHECKLIST FOR RENEWAL OF REGISTRATION AS
SAFETY AND HEALTH OFFICER (SHO)
Applications should be addressed to:
Director General,
Department of Occupational Safety and Health,
Level 2, 3 & 4, Block D3, Complex D,
Federal Government Administrative Centre,
62530 Federal Territory of Putrajaya.
(ATT: Director of Industrial Safety Division)

Name of applicant : ________________________
Phone No

: ________________________

Email

: _________________________

The following information is required (information should be in the order below): NO.

YES
(√)

ITEM

1.

Copy of N.R.I.C.

4.

NOTE

The original Certificate of Registration Book (Green Book).

3.

OFFICE USE

A letter from the applicant's mailing address along with the latest along with phone numbers and email addresses.

2.

NO
(X)

Renewal Application Form (Schedule II) properly filled.

5.

6.

Two (2) recent driving license photographs (for the second Certificate of Registration Book (Green Book))
Please write your name, N.R.I.C. No. and SHO posts in the
background.
A processing fee of RM 50.00 in the form of:
i. E-Payment – Internet online RHB bank (please attach a copy of the payment receipt)
ii. Cash – only at JKKP Head Quarters
iii. Money order / postal order / bank draft in the name of the Director General of DOSH MALAYSIA

7.

Letter of confirmation / support from employer confirming the applicant has served as a safety and health officer.

8.

Table points calculation system according to the ‘Garis Panduan Sistem Mata Bagi Program Pendidikan Berterusan’.
(Attached with the copy of certificate of 'continuous education program' attended in the registration or renewal and related evidence)

Department of Occupational Safety and Health |

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9.

10.

DEPARTMENT OF OCCUPATIONAL SAFETY AND HEALTH
Website : http://www.dosh.gov.my
Employer company profile contains information such as type of industry, number of employees, industry class under Rule
Occupational Safety and Health (Safety and Health Officer) in 1997, and other information related
Registration number of factory / workplace / construction site with Dosh and factory inspection reports / site construction / audit work (such as JKJ 17 or audit report from the State DOSH).
The evidence or duties as a safety and health officer in accordance with Rules 18 and 19, of the Occupational Safety and Health (Safety and Health Officer) Regulations 1997 for the latest three months: i. Monthly report in summary form provided by Rule 19 (2); report shall be prepared and signed by the applicant and reviewed by the employer.

11.

ii. Report audit / inspection work prepared by the applicant. iii. Minutes of meetings of the Health and Safety Committee
prepared by the applicant that the applicant and the employer shall sign the minutes.
iv. Accident Report, Health and Safety Program, Accident statistics and other related safety and health which is prepared by
applicant.

NOTE:
This checklist should be submitted with the application and read in conjunction with the Guidelines for Registration and Renewal Safety and Health Officer.
For Office Use:
DS 001 No.
:
Receipt No.
:
Registration No. :
Receive Date
:
Office Stamp
:i.
Admin

___________________________________
___________________________________
___________________________________
___________________________________
ii . Industrial Safety Division

iii. PP Unit Head

For Officer Use (BKI):
Receive Date
Document
Note

: ________________________________
: Complete / Not Complete
:

Department of Occupational Safety and Health |

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SHO

SCHEDULE II

OCCUPATIONAL SAFETY AND HEALTH ACT 1994
OCCUPATIONAL SAFETY AND HEALTH (SAFETY AND HEALTH OFFICER)
REGULATION 1997
RENEWAL OF REGISTRATION
(Regulation 11)
Expire Date

:

…………………………………………………………

1.0

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