DOCUMENT NAME LEGAL APPOINTMENTS

21.0
PRINCIPAL CONTRACTOR DOC NO
COMMENCEMENT
PROJECT NAME
DATE OF PROJECT

ADRESS

Index of the legal appointments

1. Accident - Incident Investigator 18. First Aider

2. Agent 19. Hand Tool Inspector

3. Assignment of Duties (16.2) 20. Hazardous Chemical Handler

4. Assistant Construction Manager 21. Health and Safety Committee Member

5. Assistant Construction Supervisor 22. Housekeeping

6. Construction Manager 23. Ladder Inspector

7. Construction Supervisor 24. Machinery Operator

8. Controller of Temporary Flammable Liquid 25. Machinery Supervisor

Stores 26. Personal Protective Equipment Inspector

9. Electrical Installation Supervisor 27. Portable Electrical Equipment Inspector

10. Emergency Evacuation Controller 28. Risk Assessor

11. Excavation Supervisor 29. Safety Officer

12. Explosive Actuated Fasting Device 30. Safety Representative

Controller 31. Scaffold Supervisor

13. Explosive Actuated Fasting Device 32. Stacking and Storage

Operator 33. Temporary Electrical Installation Inspector

14. Fall Protection Planner Arrest 34. Temporary Works Designer

15. Fall Protection Planner 35. Temporary Works Supervisor

16. Fire Equipment Inspector 36. Welding & Flame Cutting.

17. Fire Fighter (Team Member)

ACCIDENT / INCIDENT INVESTIGATOR

OCCUPATIONAL HEALTH AND SAFETY ACT, Act 85 of 1993

General Administrative Regulation 9 - Recording and Investigation of Incidents

GAR 9 (2) An employer or user shall cause every incident which must be recorded in terms of sub
regulation (1), to be investigated by the employer, a person appointed by him of her, by a
health and safety representative or a member of a health and safety committee within 7
days from the date of the incident and finalised as soon as is reasonably practicable, or
within the contracted period in the case of contracted workers.

I,________________________________________________________________________(Employer),

the duly appointed person in terms of the Occupational Health and Safety Act 85 of 1993,

for______________________________________________________________________(Company)

do hereby Appoint __ De Munck Menderoi(OHS Practitioner) (Employee) as the Accident Investigator

on the premises at (Area of responsibility) ______________________________________________.

Duties:

• Ensure that you investigate and report on the accidents and incidents on the prescribed
Annexure 2 forms.
• Ensure the required witnesses are questioned.
• Ensure the statements are signed and attached to all incident / accident investigations.

NB COPY OF THE ACT AND REGULATIONS IS AVAILABLE ON THE PREMISES FOR YOUR PERUSAL

Signature: ___________________________ Date: ___________________________________

ACCEPTANCE

I, ________ De Munck Menderoi (OHS Practitioner)_________________________ the

undersigned do hereby acknowledge receipt of, understand and accept this appointment.

Signature: ___________________________

Designation: Incident / Accident Investigator Date: ____________________________

 AGENT

OCCUPATIONAL HEALTH AND SAFETY ACT, Act 85 of 1993

Construction Regulation 5

REG. 5.(5) Where a construction work permit is required as contemplated in regulation 3 (1), the
client must, without derogating from his or her health and safety responsibilities or
liabilities, appoint a competent person in writing as an agent to act as his or her
representative, and where such an appointment is made the duties that are imposed by
these Regulations upon a client, apply as far as reasonably practicable to the agent so
appointed.

REG. 5.(6) Where notification of construction work is required as contemplated in regulation 4 (1),
the client may, without derogating from his or her health and safety responsibilities of
liabilities, appoint a competent person in writing as an agent to act as his or her
representative, and where such an appointment is made the duties that are imposed by
these Regulations upon a client, apply as far as reasonably practicable to the agent so
appointed.
I, ______________________________________________________________________ (Employer),

for (Company)

do hereby appoint: De Munck Menderoi (OHS Practitioner) (Employee)

as the Agent work at: __________________________________________________ (Project Name).

Special instructions / Information:

1. To assist the employer to comply with the Occupational Health and Safety Act and Regulations
(85 of 1993) and compliance to the Regulations promulgated there under.
2. Endorse Safety Representatives reports / Minutes of the meeting.
3. Report and investigate any incident as contemplated in Section 24 of the Act.
4. Ensure the "Agreement with Mandatary" as per Sect. 37.(1)(2) of the Act are complied with.
5. Ensure Risk assessments are conducted within your area of responsibility and up to date.
6. Assist with the compiling of Method statement and the development of Safe Working
Procedures.

Name: Signature:

Designation: ___________________________________ Date:

ACCEPTANCE

I, _____ De Munck Menderoi (OHS Practitioner)________________________ the undersigned do

hereby acknowledge receipt of, understand and accept this appointment.

Signature: ___________________________

Designation: Clients Agent Date: ___________________________________

 ASSIGNMENT OF DUTIES

OCCUPATIONAL HEALTH AND SAFETY ACT, Act 85 of 1993

SECTION 16 (2)

In terms of Section 16
(1) Every chief executive officer shall as far as is reasonably practicable ensure that the duties of
his employer as contemplated in this Act, are properly discharged.
(2) Without derogating from his responsibility or liability in terms of subsection (1), a Chief
Executive Officer may assign any duty contemplated in the said subsection, to any person
under his control, which person shall act subject to the control and directions of the Chief
Executive Officer.
(3) The provisions of subsection (1) shall not, subject to the provisions of section 37, relieve an
employer of any responsibility or liability under this Act.
I, __________________________________________________________________________(CEO)

for (Company)

hereby assign the following duties to _________________________________________ (Employee)

as a designated official and vest him with the duty of ensuring that the Employer complies with the
provisions of the Occupational Health & Safety Act, subject to my control and directions as Chief
Executive Officer, in respect of the following: _________________________________(Site/Address)

NOTE: - Your attention is drawn to the requirements of the Act and regulations with specific
reference included in and not limited to Sections 8, 9,13,17,19, 24, 26 & 37 of the Act.

Name: Signature:

Designation: 16.1 Date: ___________

ACCEPTANCE

I, ______________________________________________________, the undersigned acknowledge

receipt of, that I understand and accept the above assignment of responsibilities and confirm that I
am familiar with the requirements of the relevant legislation and agree to carry out my duties.

Signature: _________________________________________
Date:_________________________________

Distribution

1. Original displayed on site.

2. Copy to central files.

ASSISTANT CONSTRUCTION MANAGER

OCCUPATIONAL HEALTH AND SAFETY ACT, Act 85 of 1993

Construction Regulation 8
REG. 8 (2) A principal contractor must upon having considered the size of the project, in writing
appoint one or more assistant construction managers for different sections thereof: Provided that the
designation of any such person does not relieve the construction manager of any personal
accountability for failing in his or her management duties in terms of this regulation

I, ______________________________________________________________________ (Employer),

for (Company)

do hereby appoint: (Employee)

as the Assistant Construction Manager work at: _____________________________ (Project Name).

Special Instructions / Information:

1. Will all assume responsibilities of the Construction Manager in his absence.

2. To assist the employer to comply with the Act.
3. Endorse Safety Representatives reports.
4. Report and investigate any incident as contemplated in Section 24 of the Act.
5. Ensure Risk assessments are conducted in your area of responsibility.

Signature: Date:

ACCEPTANCE

I, ____________________________________________________________ the undersigned do hereby

acknowledge receipt of, understand and accept this appointment.

Signature: ___________________________

Designation: Assistant Construction Manager Date: _____________________________

 ASSISTANT CONSTRUCTION SUPERVISOR

OCCUPATIONAL HEALTH AND SAFETY ACT, Act 85 of 1993

Construction Regulation 8

REG. 8.(8) A contractor must, upon having considered the size of the project, in writing appoint one
or more competent employees for different sections thereof to assist the construction supervisor
contemplated in sub regulation (7), and every such employee has, to the extent clearly defined by the
contractor in the letter of appointment, the same duties as the construction supervisor: Provided that
the designation of such employee does not relieve the construction supervisor of any personal
accountability for failing in his or her supervisory duties in terms of the regulation.

I, ____________________________________________________________ (Employer),
for __ (Company)
do hereby appoint: (Employee)
as the Assistant Supervisor of Construction work at:_____________ (Project Name)

Special Instructions / Information:

1. To assist the employer to comply with the Occupational Health and Safety Act and Regulations
(85 of 1993) and compliance to the Regulations promulgated there under.
2. Endorse Safety Representatives reports / Minutes of the meeting.
3. Report and investigate any incident as contemplated in Section 24 of the Act.
4. Ensure the "Agreement with Mandatary" as per Sect. 37.(1)(2) of the Act are complied with.
5. Ensure Risk assessments are conducted within your area of responsibility and up to date.
6. Assist with the compiling of Method statement and the development of Safe Working
Procedures.

Signature: Date:
 ACCEPTANCE

I, ____________________________________________________________ the undersigned do hereby

acknowledge receipt of, understand and accept this appointment.

Signature: ___________________________

Designation: Assistant Construction Supervisor Date: _______________________

CONSTRUCTION MANAGER
OCCUPATIONAL HEALTH AND SAFETY ACT, Act 85 of 1993

Construction Regulation 8

8.(1) The principal contractor must appoint in writing one full-time competent person as the
construction manager with the duty of managing all the construction work on a single site,
including the duty of ensuring occupational health and safety compliance, and in the absence of
the construction manager an alternate must be appointed by the principal contractor.

I, _____________________________________________________________________ (Employer),

For ____________________________________________________________________ (Company)

Do hereby appoint, _______________________________________________________ (Employee)
as the Construction Manager at ____________________________________________ (Site/address)

Special Instructions / Information:

1. To assist the employer to comply with the Occupational Health and Safety Act and Regulations
(85 of 1993) and compliance to the Regulations promulgated there under.
2. Endorse Safety Representatives reports / Minutes of the meeting.
3. Report and investigate any incident as contemplated in Section 24 of the Act.
4. Ensure the "Agreement with Mandatary" as per Sect. 37.(1)(2) of the Act are complied with.
5. Ensure Risk assessments are conducted within your area of responsibility and up to date.
6. Assist with the compiling of Method statement and the development of Safe Working
Procedures.

Signature: Date:
 ACCEPTANCE

I, ____________________________________________________________ the undersigned do hereby

acknowledge receipt of, understand and accept this appointment.

Signature: ___________________________

Designation: Construction Manager Date: ___________________________________

CONSTRUCTION SUPERVISOR

OCCUPATIONAL HEALTH AND SAFETY ACT, Act 85 of 1993

Construction Regulation 8

8.(7) The construction manager must in writing appoint construction supervisors responsible for
construction activities and ensuring occupational health and safety compliance on the
construction site.
I, _____________________________________________________________________ (Employer),

For ____________________________________________________________________ (Company)

Do hereby appoint, _______________________________________________________ (Employee)
as the Supervisor of Construction at _______________________________________ (Site/address).

Special Instructions / Information:

1. To assist the employer to comply with the Occupational Health and Safety Act and Regulations
(85 of 1993) and compliance to the Regulations promulgated there under.
2. Endorse Safety Representatives reports / Minutes of the meeting.
3. Report and investigate any incident as contemplated in Section 24 of the Act.
4. Ensure the "Agreement with Mandatary" as per Sect. 37.(1)(2) of the Act are complied with.
5. Ensure Risk assessments are conducted within your area of responsibility and up to date.
6. Assist with the compiling of Method statement and the development of Safe Working
Procedures.

Signature: Date:
 CONSTRUCTION VEHICLE AND MOBILE PLANT

ACCEPTANCE

I, ____________________________________________________________ the undersigned do hereby

acknowledge receipt of, understand and accept this appointment.

Signature: ___________________________

Designation: Construction Supervisor Date: ___________________________________

OCCUPATIONAL HEALTH AND SAFETY ACT, Act 85 of 1993

Construction Regulation 23(1)(k)

23. Construction Vehicles and Mobile Plant

(1) A contractor must ensure that all construction vehicles and mobile plant-
(a) are of an acceptable design and construction;
(b) are maintained in a good working order;
(c) are used in accordance with their design and the intention for which they were designed, having
due regard to safety and health;
(d) are operated by a person who-
(i) has received appropriate training, is certified competent and in possession of proof of
competency and is authorized in writing to operate those construction vehicles and mobile
plant;
(ii) has a medical certificate of fitness to operate those construction vehicles and mobile plant,
issued by an occupational health practitioner in the form of Annexure 3.;
(e) have safe and suitable means of access and egress;
(f) are properly organized and controlled in any work situation by providing adequate signalling or
other control arrangements to guard against the dangers relating to the movement of vehicles and
plant, in order to ensure their continued safe operation;
(g) are prevented from falling into excavations, water or any other area lower than the working surface
by installing adequate edge protection, which may include guardrails and crash barriers;
(h) are fitted with structures designed to protect the operator from falling material or from being
crushed should the vehicle or mobile plant overturn;
(i) are equipped with an acoustic warning device which can be activated by the operator;
(j) are equipped with an automatic acoustic reversing alarm; and
(k) are inspected by the authorized operator or driver on a daily basis using a relevant checklist prior
to use and that the findings of such inspection are recorded in a register kept in the construction
vehicle or mobile plant.
I, (Employer),

for (Company)

do hereby appoint: (Employee)

as Construction Vehicle and mobile plant supervisor over his area:

________________________________________ (Site Name).

Signature: ___________________________ Date: ___________________________________

 ACCEPTANCE

I, ____________________________________________________________ the undersigned do hereby

acknowledge receipt of, understand and accept this appointment.

Signature: ___________________________

Designation: Construction Vehicle and Mobile Plant Date: ____________________________

CONTROLLER OF TEMPORARY FLAMMABLE LIQUID STORES

OCCUPATIONAL HEALTH AND SAFETY ACT, Act 85 of 1993

Construction Regulation 25

25. A contractor must, in addition to compliance with the provisions for the use and storage of
flammable liquids in the General Safety Regulations, 2003, ensure that -

GSR 4. Use and storage of flammable liquids. -

(1) No employer shall require or permit any person to work in a place where the vapour of any
flammable liquid is generated to such an extent that it constitutes an actual or potential fire or
explosion hazard or endangers, the safety of any person, unless the provisions of subregulation
(2) to (12) of this regulation are complied with.
I, _____________________________________________________________________ (Employer),

For ____________________________________________________________________ (Company)

Do hereby appoint, _______________________________________________________ (Employee)
as the Controller of temporary flammable liquid stores at ______________________ (Site/address).
Duties:

1. Ensure compliance with the Construction Regulation 25 & GSR 4.(1).

2. Ensure that unauthorised access to flammable liquid storage areas are controlled.
3. Ensure the storage area is locked at all times.
4. Ensure the storage area is maintained in a safe state.
5. Ensure all flammable liquids leaving the store are signed for on register.
6. Ensure you maintain a register of flammable liquids in storage and their quantities.
7. Ensure you have MSDS's for all flammable liquids in storage.
8. Ensure the required safety signage and fire protection is available.
9. Report all unsafe conditions.

Signature: Date:

ACCEPTANCE

I, ____________________________________________________________ the undersigned do hereby

acknowledge receipt of, understand and accept this appointment.

Signature: ___________________________

Designation: Controller of Temporary Flammable Liquid Stores Date: ________________

 ELECTRICAL INSTALLATION SUPERVISOR

OCCUPATIONAL HEALTH AND SAFETY ACT, Act 85 of 1993

Construction Regulations 24

24. A contractor must, in addition to compliance with the Electrical Installation Regulations, 2009,
and the Electrical Machinery Regulation, 1988, promulgated by Government Notice No. R. 1593
of 12 August 1988, ensure that-

(c) the control of all temporary electrical installations on the construction site is designated to a
competent person who has been appointed in writing for that purpose;

I, _____________________________________________________________________ (Employer),

the duly assigned person in terms of Section 16 (2) of the Act,

For ____________________________________________________________________ (Company)

Do hereby appoint, _______________________________________________________ (Employee)
as the competent person in term of CR 24.(d)(e) to ensure that the requirements of the applicable
regulation is complied with at ____________________________________________ (Site/address).
Duties CR 24:

• (d) all temporary electrical installations used by the contractor are inspected at least once
a week by a competent person and the inspection findings are recorded in a register kept
on the construction site; and
• (e) all electrical machinery is inspected by the authorised operator or user on a daily basis
using a relevant checklist prior to use and the inspection findings are recorded in a register
kept on the construction site.

Signature: Date:

ACCEPTANCE

I, ____________________________________________________________ the undersigned do hereby

acknowledge receipt of, understand and accept this appointment.

Signature: ___________________________

Designation: Electrical Installation Supervisor Date: ___________________________________

 EMERGENCY EVACUATION CONTROLLER

OCCUPATIONAL HEALTH AND SAFETY ACT, Act 85 of 1993

Construction Regulation 29

29. Subject to the provisions of the Environmental Regulations for Workplaces promulgated by
Government Notice No. R.2281 of 16 October 1987, as amended,

I, ______________________________________________________ (Employer Responsible Person),

For (Company)

Do hereby appoint: (Employee)

As the Emergency Evacuation Controller for the: _______________________________ (Site Name).

Duties:

1. Ensure compliance with the Construction Regulation 29.

2. Ensure all personnel comply with the Emergency Evacuation Procedures.

3. Ensure preservation of life and property under all emergency conditions.

4. Ensure orderly evacuation of the area in the event of emergency

Signature: ___________________________ Date: ___________________________________

ACCEPTANCE

I, ____________________________________________________________ the undersigned do hereby

acknowledge receipt of, understand and accept this appointment.

Signature: ___________________________

Designation: Emergency Evacuation Controller Date: ___________________________________

 EXCAVATION SUPERVISOR

OCCUPATIONAL HEALTH AND SAFETY ACT, Act 85 of 1993

CONSTRUCTION REGULATION 13

(1) A contractor must -

(a) ensure that all excavation work is carried out under the supervision of a competent person who has
been appointed in writing for that purpose.

Apply General Safety Regulations 13(b) to (h).

I, ______________________________________________________ (Employer Responsible Person),

For (Company)

Do hereby appoint: (Employee)

As the Excavation Supervisor of Construction Work for the: ______________________ (Site Name).

Signature: ___________________________ Date: ___________________________________

ACCEPTANCE

I, ____________________________________________________________ the undersigned do hereby

acknowledge receipt of, understand and accept this appointment.

Signature: ___________________________

Designation: Excavation Supervisor Date: ___________________________________

 EXPLOSIVE ACTUATED FASTENING DEVICE CONTROLLER

OCCUPATIONAL HEALTH AND SAFETY ACT, Act 85 of 1993

Construction Regulation 21

(1) No contractor may use or permit any person to use an explosive actuated fastening device,
unless -

(a) the user is provided with and uses suitable protective equipment;
(b) the user is trained in the operation, maintenance and use of such a device;
(c) the explosive actuated fastening device is provided with a protective guard around the
muzzle end, which effectively confines any flying fragments or particles; and
(d) the firing mechanism is so designed that the explosive actuated fastening device, will
not function unless -
(i) it is held against the surface with a force of at least twice its weight; and
(ii) the angle of inclination of the barrel to work surface is not more that 15 degrees from
a right angle.

I, ___________________________________________________________ (Employer Responsible Person),

For __________________________________________________________________________ (Company)

Do hereby appoint: _____________________________________________________________ (Employee)

As the Explosive Power Tool Controller for the: _____________________________________ (Site Name).

Signature: ___________________________ Date: ___________________________________

ACCEPTANCE

I, ____________________________________________________________ the undersigned do hereby

acknowledge receipt of, understand and accept this appointment.

Signature: ___________________________

Designation: Explosive Actuated Fastening Device Controller Date: ________________________

 FALL PROTECTION ARREST / PREVENTION EQUIPMENT INSPECTOR
OCCUPATIONAL HEALTH AND SAFETY ACT, Act 85 of 1993

Construction Regulation 10

A contractor must -

(2) A fall protection plan contemplated in subregulation (1), must include -

(d) the procedure addressing the inspection, testing and maintenance of all fall
protection equipment;

I, ___________________________________________________________ (Employer Responsible Person),

For __________________________________________________________________________ (Company)

Do hereby appoint: _____________________________________________________________ (Employee)

As the Fall Arrest / prevention equipment Inspector for the: _____________________ (Site Name)

Duties:

1. That all fall arrest and prevention equipment is numbered / identifiable.

2. That the relevant information is reflected in the appropriate register.
3. Inspect all equipment and items are inspected at the prescribed intervals - daily and the results
recorded.
4. The deviations observed are addressed in time.
5. Faulty appliance / equipment is removed from service and sent for repair etc.
6. Ensure that there are sufficient appliances / equipment is available for use.
7. Report to Site Agent any tampering with equipment.

Signature: ___________________________ Date: ___________________________________

 ACCEPTANCE

I, ____________________________________________________________ the undersigned do hereby

acknowledge receipt of, understand and accept this appointment.

Signature: ___________________________

Designation: Fall Protection Arrest / Prevention Equipment Inspector Date: _____________

FALL PROTECTION PLANNER

OCCUPATIONAL HEALTH AND SAFETY ACT, Act 85 of 1993

Construction Regulation 10

(1) A contractor must -

(a) The designation of a competent person, responsible for the preparation of a fall protection
plan;

I, ___________________________________________________________ (Employer Responsible Person),

For __________________________________________________________________________ (Company)

Do hereby appoint: ____________________________________________________________ (Employee)

As the Fall Protection Planner for the: ______________________________________ (Site Name).

Duties:

1. Ensure compliance with the construction regulation 10 (b).

2. Compile a fall protection plan for the project.
3. Implement the fall protection plan and amend where required.
4. Take steps to ensure all employees adhere to the plan.
5. Ensure risk assessments are conducted prior to commencing work in elevated positions.
6. Ensure persons required to work in elevated positions are physically and psychologically fit.
7. Ensure all employees required to work in elevated positions are trained.
8. Ensure all fall arrest equipment is inspected and maintained.
9. Ensure the construction supervisor is issued the latest version of the fall protection plan.
10. Ensure Roof work is included in the planning.

Signature: ___________________________ Date: ___________________________________

ACCEPTANCE

I, _________________________________ the undersigned do hereby acknowledge receipt of,

understand and accept this appointment.

Signature: ___________________________

Designation: Fall Protection Planner Date: ___________________________________

 FIRE EQUIPMENT INSPECTOR

OCCUPATIONAL HEALTH AND SAFETY ACT, Act 85 of 1993

Construction Regulation 29

A contractor must, in addition to compliance with the Environmental Regulations for Workplaces,
1987, ensure that –
(h) the fire equipment contemplated in paragraph (g) is inspected by a competent person, who has
been appointed in writing for that purpose, in the manner indicated by the manufacturer
thereof;

Environmental Regulation 9

(1) Having regard to the size, construction and location of the workplace, and the amount and type
of flammable articles used, handled or stored on the premises. And the employer shall provide
on the premises an adequate supply of suitable fire-fighting equipment at strategic locations or
as may be recommended by the fire chief of the local authority concerned, and such equipment
shall be maintained in good working order.

I, ___________________________________________________________ (Employer Responsible Person),

For __________________________________________________________________________ (Company)

Do hereby appoint: _____________________________________________________________ (Employee)

As the Fire Equipment Inspector for the: _____________________________________ (Site Name).

Duties: -

Ensure that all fire equipment is maintained in accordance with Environmental Regulation 9.

Signature: ___________________________ Date: ___________________________________

ACCEPTANCE

I, ____________________________________________________________ the undersigned do hereby

acknowledge receipt of, understand and accept this appointment with regards to fire equipment.

Signature: ___________________________

Designation: Fire Equipment Inspector Date: ___________________________________

 FIRE FIGHTER (TEAM MEMBER)

OCCUPATIONAL HEALTH AND SAFETY ACT, Act 85 of 1993

Construction Regulation 29

29. A contractor must, in addition to compliance with the Environmental Regulations for
Workplaces, 1987, ensure that - …

g) suitable and sufficient fire-extinguishing equipment is placed at strategic locations or as may be

recommended by the Fire Chief or local authority concerned, and that such equipment is maintained in a
good working order;
(h) the fire equipment contemplated in paragraph (g) is inspected by a competent person, who has been
appointed in writing for that purpose, in the manner indicated by the manufacturer thereof;
(i) a sufficient number of workers are trained in the use of fire- extinguishing Equipment;

The fire fighter will maintain and inspect all fire equipment and in case of a fire use all safety precautions to
put out the fire

I, ___________________________________________________________ (Employer Responsible Person),

For __________________________________________________________________________ (Company)

Do hereby appoint: _____________________________________________________________ (Employee)

As the Fire Fighter (Team Member) for the: ___________________________________ (Site Name).

Signature: ___________________________ Date: ___________________________________

ACCEPTANCE

I, ____________________________________________________________ the undersigned do hereby

acknowledge receipt of, understand and accept this appointment with regards to fire fighting.

Signature: ___________________________

Designation: Fire Fighter (Team Member) Date: ___________________________________

 FIRST AIDER

OCCUPATIONAL HEALTH AND SAFETY ACT, Act 85 of 1993

General Safety Regulations 3.(4)

(4) Where more than 10 employees are employed at a workplace, the employer of such employees
shall take steps to ensure that for every group of up to 50 employees at that workplace, or in the
case of a shop or an office as contemplated in the Basic Condition of Employment Act, 1983 (Act
No. 3 of 1983), for every group of up to 100 employees, at least one person is readily available
during normal working hours, who is in possession of a valid certificate of competency in first aid,
issued by-
(a) the SA Red Cross Society;
(b) the St John Ambulance;
(c) the SA First Aid League; or
(d) a person or organization approved by the chief inspector for this purpose.

I, ___________________________________________________________ (Employer Responsible Person),

For __________________________________________________________________________ (Company)

Do hereby appoint: _____________________________________________________________ (Employee)

As First Aider and to ensure that all first aid boxes are maintained in accordance with General Safety

Regulation 3 at _______________________________________________________ (Site/Address).

Period, END OF CONTRACT _____________________

Signature: ___________________________ Date: ___________________________________

ACCEPTANCE

I, ____________________________________________________________ the undersigned do hereby

acknowledge receipt of, understand and accept this appointment with regards to first aid.

Signature: ___________________________

Designation: First Aider Date: ___________________________________

 HAZARDOUS CHEMICAL SUBSTANCE HANDLER

OCCUPATIONAL HEALTH AND SAFETY ACT, Act 85 of 1993

In terms of Hazardous Chemical Substances Regulations

The Hazardous Chemical Substances Regulations of the Occupational Health and Safety Act (85 of
1993) requires that every employer or self-employed person who carries out work at a workplace
which may expose any person to the intake of an HCS at that workplace to ensure that it be carried
out in a safe manner

I, Romeo Bowman (Employer) for Alert Developments (Company) do hereby appoint Jody Thomas

(Employee) As the Hazardous Chemical Substance handler at Smitsville Phase 3 (Site Name).

Period,

Signature: ___________________________ Date: Tuesday, 31 January 2023

ACCEPTANCE

I, Jody Thomas, the undersigned do hereby acknowledge receipt of, understand and accept this appointment.

Signature: ___________________________

Designation: Hazardous Chemical Substance Handler Date: Tuesday, 31 January 2023

HAND TOOL INSPECTOR

OCCUPATIONAL HEALTH AND SAFETY ACT, Act 85 of 1993

In terms of Act Section 8

(2) Without derogating from the generality of an employer's duties under subsection (1), the

matters to which those duties refer include in particular -

(a) the provision and maintenance of systems of work, plant and machinery that, as far as is

reasonably practicable, are safe and without risks to health;

I, (Employer),

For (Company)

Do hereby appoint, ______________________________________________________ (Employee)

As the Hand Tool Inspector for the: __________________________________________ (Site Name).

Period,

Signature: ___________________________ Date: ___________________________________

 ACCEPTANCE

I, ____________________________________________________________ the undersigned do hereby

acknowledge receipt of, understand and accept this appointment.

Signature: ___________________________

Designation: Hand Tool Inspector Date: ___________________________________

HEALTH AND SAFETY COMMITTEE MEMBER

OCCUPATIONAL HEALTH AND SAFETY ACT, Act 85 of 1993

Section 19 Health and Safety Committees

(1) An employer shall in respect of each workplace where two or more health and safety
representatives have been designated, establish one or more health and safety committees
and, at every meeting of such committee as contemplated in subsection (4), consult with the
committee with a view to initiating, developing, promoting, maintaining and reviewing
measures to ensure the health and safety of his employees at work.

(2) A health and safety committee shall consist of such number of members as the employer may
from time to time determine: Provided that -

(a) if one health and safety committee has been established in respect of a workplace, all the
health and safety representatives for that workplace shall be members of the committee;

(b) if two or more health and safety committees have been established in respect of a
workplace, each health and safety representative for that workplace shall be a member of
at least one of those committees; and

(c) the number of persons nominated by an employer on any health and safety committee
established in terms of this section shall not exceed the number of health and safety
representatives of that committee.

(3) The persons nominated by an employer on a health and safety committee shall be designated in
writing by the employer for such period as may be determined by him, while the health and
safety representatives shall be members of the committee for the period of their designation in
terms of section 17 (1).

(4) A health and safety committee shall hold meetings as often as may be necessary, but at least
once every three months, at a time and place determined by the committee: Provided that an
inspector may by notice in writing direct the members of a health and safety committee to hold
 a meeting at a time and place determined by him: Provided further that, if more than 10
percent of the employees at a specific workplace has handed a written request to an inspector,
the inspector may by written notice direct that such a meeting be held.

(5) The procedure at meetings of a health and safety committee shall be determined by the
committee.

(6) (a) A health and safety committee may co-opt one or more persons by reason of his or their
particular knowledge of health or safety matters as an advisory member or as advisory
members of the committee, (b) An advisory member shall not be entitled to vote on any matter
before the committee.

(7) If an inspector is of the opinion that the number of health and safety committees established
for any particular workplace is inadequate, he may in writing direct the employer to establish
for such workplace such number of health and safety committees as the inspector may
determine.

I, (Employer),

For (Company)

Do hereby appoint, ______________________________________________________ (Employee)

as a Health and Safety Committee member over his area: _______________________ (Site Name).

Period: _________________

Signature: ______________________________ Date: ___________________________________

 ACCEPTANCE

I, ____________________________________________________________ the undersigned do hereby

acknowledge receipt of, understand and accept this appointment.

Signature: ___________________________

Designation: Health and Safety Committee Member Date: ______________________________

HOUSEKEEPING

OCCUPATIONAL HEALTH AND SAFETY ACT, Act 85 of 1993

Construction Regulation 30.1

A contractor must, in addition to compliance with the Environmental Regulations for Workplaces, 1987,
promulgated by Government Notice No. R. 2281 of 16 October 1987, ensure that suitable housekeeping is
continuously implemented on each construction site;

I, _____________________________________________________________________________(Employer),

For ___________________________________________________________________________ (Company)

Do hereby appoint, _____________________________________________________________ (Employee)

as Housekeeping Inspector over his area: ______________________________________(Site Name).

Period,

Signature: __________________________ Date:

 ACCEPTANCE

I, ___________________________________, the undersigned do hereby acknowledge receipt of,

understand and accept this appointment.

Signature: ___________________________

Designation: Housekeeping Date: ______________________________

LADDER INSPECTOR

OCCUPATIONAL HEALTH AND SAFETY ACT, Act 85 of 1993

General Safety Regulation 13A

(1) An employer shall ensure that every ladder is constructed of sound material and is suitable for
the purpose for which it is used, and –
a) is fitted with non-skid devices at the bottom ends and hooks or similar devices at the upper ends
of the stiles which shall ensure the stability of the ladder during normal use; or
(b) is so lashed, held or secured whilst being used as to ensure the stability of the ladder under all
conditions and at all times.

I, _____________________________________________________________________________(Employer),

For ___________________________________________________________________________ (Company)

Do hereby appoint, _____________________________________________________________ (Employee)

as Ladder Inspector over his area: __________________________________________ (Site Name).

Period, ____________________________________

Duties:

1. Ensure that all ladders are numbered,

2. Inspect all ladders monthly and record all findings on the register provided for this.
3. Report all defects found.
4. Checklist is recorded yes or no and not "ticked".

Signature: ___________________________ Date: ___________________________________

 MACHINERY OPERATOR

ACCEPTANCE

I, ____________________________________________________________ the undersigned do hereby

acknowledge receipt of, understand and accept this appointment.

Signature: ___________________________

Designation: Ladder Inspector Date: ___________________________________

OCCUPATIONAL HEALTH AND SAFETY ACT, Act 85 of 1993

General Machinery Regulations 4

(1) An employer or user of machinery shall ensure that every person authorised to operate
machinery is fully aware of the dangers attached thereto and is conversant with the
precautionary measures to be taken or observed to obviate such dangers.

I, (Employer),

for (Company)

do hereby appoint: (Employee)

as Machinery Operator over his area: ________________________________________ (Site Name).

Signature: ___________________________ Date: ___________________________________

 MACHINERY SUPERVISOR

OCCUPATIONAL HEALTH AND SAFETY ACT, Act 85 of 1993

ACCEPTANCE

I, ____________________________________________________________ the undersigned do hereby

acknowledge receipt of, understand and accept this appointment.

Signature: ___________________________

Designation: Machine Operator Date: ___________________________________

General Machinery Regulations 2

GMR. 2.(1) In order to ensure that the provisions of the Act and these Regulations in relation to
machinery are complied with, an employer or user of machinery shall, subject to this regulation, in
writing designate a person in a full-time capacity in respect of every premises on or in which
machinery is being used.

I, (Employer),

for (Company)

do hereby appoint: (Employee)

as Machinery Supervisor over his area: _______________________________________ (Site Name).

Signature: Date:

ACCEPTANCE

I, ____________________________________________________________ the undersigned do hereby

acknowledge receipt of, understand and accept this appointment.

Signature: ___________________________

Designation: Machine Supervisor Date: ___________________________________

 PERSONAL PROTECTIVE EQUIPMENT INSPECTOR

OCCUPATIONAL HEALTH AND SAFETY ACT, ACT 85 OF 1993 AS AMENDED

GENERAL ADMINISTRATIVE REGULATIONS

Subject to the provisions of paragraphs (f), (g), (h) and (i) of regulation 5 of the General
Administrative Regulations published under Government Notice R.2206 of 5 October 1984, every
employer and every user of machinery shall make an evaluation of the risk attached to any condition
or situation which may arise from the activities of such employer or user, as the case may be, and to
which persons at a workplace or in the course of their employment or in connection with the use of
machinery are exposed, and he shall take such steps as may under the circumstances be necessary to
make such condition or situation safe.
In terms of the above mentioned:

I, (Employer),

for (Company)

do hereby appoint: (Employee)

as personal protective equipment inspector at ________________ _________________________

(Site/address).

Signature: __________________________

For:

Date:

ACCEPTANCE

I, ______________________________, accept this appointment. I am familiar with the Act and Regulations
and the associated duties and responsibilities.

Signed: ____________________

Designation: PPE Inspector Date: _______________________

 PORTABLE ELECTRICAL EQUIPMENT INSPECTOR

OCCUPATIONAL HEALTH AND SAFETY ACT, Act 85 of 1993

Electrical Machinery Regulation 10 (4)

"The user shall maintain every portable electric tool, together with it’s flexible cord and plug, in a
serviceable condition."

Definition: Portable electric tool.

"Portable electric tool" means any electrically operated implement, with the exception of ordinary
household electrical appliances, which is designed for use with -
(a) a flexible cord at the supply end and which is intended for use by hand to be carried by hand at
the place of work;
(b) a flexible cable at the end and which is intended for use by hand and to be moved by hand at
the place of work.
I, (Employer),

for (Company)

do hereby appoint: (Employee)

to ensure that all Portable Electrical Equipment is inspected/maintained at ________________

_________________________ (Site/address).

Signature: Date:
 ACCEPTANCE

I, ____________________________________________________________ the undersigned do hereby

acknowledge receipt of, understand and accept this appointment.

Signature: ___________________________

Designation: Portable Electrical Equipment Inspector Date: __________________________

RISK ASSESSOR
OCCUPATIONAL HEALTH AND SAFETY ACT, Act 85 of 1993

Construction Regulation 9

(1) A contractor must, before the commencement of any construction work and during such
construction work, have risk assessments performed by a competent person appointed in
writing, which risk assessments form part of the health and safety plan to be applied on the
site, and must include -

(a) the identification of the risks and hazards to which persons may be exposed to;
(b) the analysis and evaluation of the risks and hazards identified based on a documented
method;
(c) a documented plan and applicable safe work procedures to mitigate, reduce or control
the risks and hazards that have been identified;
(d) a monitoring plan; and
(e) a review plan.
I, ___________________________________________________________________________ (Employer),

For __________________________________________________________________________ (Company)

do hereby appoint: _____________________________________________________________ (Employee)

as Risk Assessor over his area: ___________________________________________________ (Site Name).

Duties:
1. Ensure compliance with Construction Regulation 9 (1).
2. Ensure risk assessments are conducted prior to work commencing on site.
3. Ensure risk assessments are reviewed at regular intervals.
4. Ensure employees are trained to know and understand the risks.
5. Ensure the Task Risk Assessments are updated in conjunction with the risk assessments.

Signature: ___________________________ Date: ___________________________________

ACCEPTANCE
I, _______________________________________________________________the undersigned do
hereby acknowledge receipt of, understand and accept this appointment.

Signature: ___________________________

Designation: Risk Assessor Date: ___________________________________

 SAFETY OFFICER

OCCUPATIONAL HEALTH AND SAFETY ACT, Act 85 of 1993

Construction Regulation 8

(5) A contractor must, after consultation with the client and having considered the size of the

project, the degree of danger likely to be encountered or the accumulation of hazards or risks

on the site, appoint a full-time or part-time construction health and safety officer in writing to

assist in the control of all health and safety related aspects on the site: Provided that, where the

question arises as to whether a construction health and safety officer is necessary, the decision

of an inspector is decisive.

I,_______________________________________________________________________ (Employer),

The duly assigned person in terms of the Act Section 16(2) for ______________________(Company)

Do hereby appoint: ________________________________________________________ (Employee)

As the Safety Officer in terms of the Construction Regulation 8(5) on the premises at:

_________________________________(Site/address)

Duties:

1. Assist in compiling the SHE Plan

2. Assist with risk identification, evaluation and development of safe work procedures.

3. Conduct or have conducted a hazard analysis and take the necessary corrective action.

4. Ensure all accidents are properly recorded, reported and investigated.

5. Ensure Safety Meetings are held regularly and the results recorded.

6. Ensure Health and Safety Representatives conduct monthly inspections and submit the required

reports.

7. Ensure the contractors comply with the health and safety specifications.

8. Issue non-conformances and keep record of the same where required.

9. Assist with establishment of the fall protection plan.

 10. Where it is not possible to remove any remaining hazard/s you are to inform employees thereof and

what precautionary action is to be taken.

11. Ensure appropriate restoration of areas affected by construction.

12. Detail mitigating measures required to be taken, and the procedures for their implementation to the

Project Manager.

13. Establish the reporting system to be undertaken during construction and ensure effective reporting to

management on the deviations identified and required action to be taken.

14. Ensure EMP compliance.

15. Ensure monthly Safety, Health and Environmental reports are submitted to the Project Manager.

16. Ensure the implementation with the Company System Procedures for Health and Safety.

17. Ensure statistics are maintained on site regarding accidents, injuries, man-hours, lost time and risk

assessments.

18. Ensure training needs are identified and implemented.

19. Assist with Induction training

Signature: ___________________________ Date: ___________________________________

ACCEPTANCE

I, ____________________________________________________________ the undersigned do hereby

acknowledge receipt of, understand and accept this appointment.

Signature: ___________________________

Designation: Safety Officer Date: ___________________________________

 SAFETY REPRESENTATIVE

OCCUPATIONAL HEALTH AND SAFETY ACT, Act 85 of 1993

17. Health and Safety Representatives

(1) Subject to the provisions of subsection (2), every employer who has more than 20 employees in
his employment at any workplace, shall, within four months after the commencement of this
Act or after commencing business, or from such time as the number of employees exceeds 20,
as the case may be, designate in writing for a specified period health and safety representatives
for such workplace or for different sections thereof.

18. Functions of a Health and Safety Representative

(1). A health and safety representative may perform the following functions in respect of the
workplace or section of the workplace for which he has been designated, namely -
(a) review the effectiveness of health and safety measures;
(b) identify potential hazards and potential major incidents at the workplace;
(c) in collaboration with his employer, examine the causes of incidents at the workplace;
(d) investigate complaints by any employee relating to that employee's health and safety at
work;
(e) make representations to the employer or a health and safety committee on matters
arising from paragraphs(a), (b), (c) or (d) or where such representations are unsuccessful,
to an inspector;
(f) make representation to the employer on general matters affecting the health or safety of
the employees at the workplace;
(g) inspect the workplace, including any article, substance, plant, machinery or health and
safety equipment at the workplace with a view to the health and safety of employees, at
such intervals as may be agreed upon with the employer, who may be present during the
inspection;
(h) participate in consultations with inspectors at the workplace and accompany inspectors
on inspections of the workplace;
(i) receive information from inspectors as contemplated in section 36; and
(j) In his capacity as a health and safety representative attend meetings of the health and
safety committee of which he is a member, in conjunction with any of the above
functions.
I, ___________________________________________________________________________ (Employer),
For __________________________________________________________________________ (Company)
do hereby appoint: _____________________________________________________________ (Employee)
As a Health and Safety Representative over his area of responsibility for the
__________________________________________________________________ (Site/address)
Period,
Signature: Date:
 SCAFFOLD SUPERVISOR
ACCEPTANCE

I, ____________________________________________________________ the undersigned do hereby

acknowledge receipt of, understand and accept this appointment.

Signature: ___________________________

Designation: Safety Representative Date: ___________________________________

OCCUPATIONAL HEALTH AND SAFETY ACT, Act 85 of 1993

Construction Regulation 16

(1) A contractor must appoint a competent person in writing who must ensure that all scaffolding
work operations are carried out under his or her supervision and that all scaffold erectors,
team leaders and inspectors are competent to carry out their work.

I,____________________________________________________________________________ (Employer),

For __________________________________________________________________________ (Company)

Do hereby designate _____________________________________________________________(Employee)

as the SCAFFOLD SUPERVISOR at ________________________________________________ (Site/address)

Special Instructions / Information:

Signature: Date:

ACCEPTANCE

I, ____________________________________________________________ the undersigned do hereby

acknowledge receipt of, understand and accept this appointment.

Signature: ___________________________

Designation: Scaffolding Supervisor Date: ________________________________

 STACKING AND STORAGE

OCCUPATIONAL HEALTH AND SAFETY ACT, Act 85 of 1993

Construction Regulation 28

A contractor must, in addition to compliance with the provisions for the stacking of articles in the
General Safety Regulations, 2003, ensure that -

(a) A competent person is appointed in writing with the duty of supervising all stacking and
storage on a construction site;

General Safety Regulation 8

Stacking of articles
(1)(a) the stacking operation is executed under the personal supervision of a person with specific
knowledge and experience of this type of work.

I,____________________________________________________________________________ (Employer),

For __________________________________________________________________________ (Company)

Do hereby designate _____________________________________________________________(Employee)

As the Stacking Supervisor to ensure all packing and stacking is being carried out safely and in

accordance with set standards at _________________________________________ (Site/address).

Signature: Date:
 TEMPORARY ELECTRICAL INSTALLATION INSPECTOR

OCCUPATIONAL HEALTH AND SAFETY ACT, Act 85 of 1993

ACCEPTANCE

I, ____________________________________________________________ the undersigned do hereby

acknowledge receipt of, understand and accept this appointment.

Signature: ___________________________

Designation: Stacking & Storage Date:

___________________________________

Construction Regulation 24

A Contractor must, in addition to compliance with the Electrical Installation Regulations, 2009, and
the Electrical Machinery Regulations, 1988, promulgated by Government Notice No. R.1593 of 12
August 1988, ensure that -

d) all temporary electrical installations used by the contractor are inspected as least once a week
by a competent person and the inspection findings are recorded in a register kept on the
construction site; and …

I, (EmployerResponsible Person),

for (Company)

do hereby appoint: (Employee)

as the Temporary Electrical Installation Inspector for the:

(Site Name)

Signature: Date:
 TEMPORARY WORKS DESIGNER

OCCUPATIONAL HEALTH AND SAFETY ACT, Act 85 of 1993

Construction Regulation 12

ACCEPTANCE

I, ____________________________________________________________ the undersigned do hereby

acknowledge receipt of, understand and accept this appointment.

Signature: ___________________________

Designation: Temporary Electrical Installation Inspector Date: _________________________

(1) A contractor must appoint a temporary works designer in writing to design, inspect and
approve the erected temporary works on site before use.

I, _______________________________________________________(Employer Responsible Person),

For (Company)

Do hereby appoint: (Employee)

As the form work and Support Work Inspector for the Project:

(ProjectName)

Duties:

1. Ensure compliance with the Construction Regulation 12.

2. Ensure form work and support work structures are adequately designed, erected, supported,
braced and maintained so as to ensure it can withstand the load.
3. Ensure health and safety of persons is not affected where reasonably practicable.
4. Ensure support work or form work remains in place until concrete has achieved required
strength.
5. Ensure safe access to the structure.
6. Ensure employees engaged in this activity are adequately trained to perform the work safely.
7. Ensure foundations are stable.
8. Ensure where form work or support work is found to be damaged or weakened to such a degree
that its integrity is affected, it shall be removed or reinforced immediately.

Signature: Date:
 ACCEPTANCE

I, ____________________________________________________________ the undersigned do hereby

acknowledge receipt of, understand and accept this appointment.

Signature: ___________________________

Designation: Temporary Works Designer Date: ________________________________

TEMPORARY WORKS SUPERVISOR

OCCUPATIONAL HEALTH AND SAFETY ACT, Act 85 of 1993

Construction Regulation 12

(2) A contractor must ensure that all temporary works operations are carried out under the
supervision of a competent person who has been appointed in writing for that purpose.

I, _____________________________________________________________ (Employer Responsible Person),

For ____________________________________________________________________________ (Company)

Do hereby appoint: _______________________________________________________________ (Employee)

As the Form work and Support Work Supervisor for the Project:

____________________________________________________________________ (Project Name).

Duties:
1. Ensure compliance with the Construction Regulation 12.
2. Ensure form work and support work structures are adequately designed, erected, supported,
braced and maintained so as to ensure it can withstand the load.
3. Ensure health and safety of persons is not affected where reasonably practicable.
4. Ensure support work or form work remains in place until concrete has achieved required
strength.
5. Ensure safe access to the structure.
6. Ensure employees engaged in this activity are adequately trained to perform the work safely.
7. Ensure foundations are stable.

Signature: Date:

31
 ACCEPTANCE

I, ____________________________________________________________ the undersigned do hereby

acknowledge receipt of, understand and accept this appointment.

Signature: ___________________________

Designation: Temporary Works Supervisor Date: ______________________________

WELDING, FLAME CUTTING, SOLDERING AND SIMILAR OPERATIONS

OCCUPATIONAL HEALTH AND SAFETY ACT, Act 85 of 1993

GENERAL SAFETY REGULATIONS 9

(1) No employer or user of machinery shall require or permit welding or flame cutting operations to
be undertaken, unless

a) The person operating the equipment has been fully instructed in the safe operation and
use of such equipment and in the hazards which may arise from it's use.

I, ___________________________________________________________________________ (Employer),

The duly assigned person in terms of the Act Section 16(2) for ___________________________ (Company)

Do hereby appoint: _____________________________________________________________ (Employee)

As the inspector of welding, flame cutting, soldering and similar operations in terms of GSR 9(1 )(a) on the

premises at: ________________________________________________________________ (Site/address)

Duties:
Conduct or have conducted a hazard analysis and take the necessary corrective action.
Where it is not possible to remove any remaining hazard/s you are to inform employees thereof and
what precautionary action is to be taken.
Ensure that only authorized persons are allowed to enter onto and or work on the premises / site

Specific instructions:
Inspect and record deviations found with all Workshop welding and flame cutting equipment.
(Monthly)
1. Where equipment is found to be faulty, report on the deviations to management immediately
and remove the equipment from service.
2. Report on the status of this equipment at monthly safety committee meetings.
3. Report on the need for the issue of Hot Work permits in the workplace.

Signature: ___________________________ Date: ___________________________________

ACCEPTANCE

I, ____________________________________________________________ the undersigned do hereby

acknowledge receipt of, understand and accept this appointment.

Signature: ___________________________

Designation: Welding Operator Date:______________________________

DOCUMENT NAME COMPETENCY CERTIFICATES

22.0
PRINCIPAL CONTRACTOR DOC NO
COMMENCEMENT
PROJECT NAME
DATE OF PROJECT

ADRESS
COMPETENCY CERTIFICATE

Herewith we certify that

____________________
ID No.: _____________________
Received sufficient training and experience on the job

with more than 2 years of experience (GSR 11.(2))

thus declaring him competent in the following trade:

1.) CONTRACTS MANAGER

2.) H&S COMMITTEE MEMBER

3.)

Awarded on this

03rd day of JULY in the year 2018

_________________________________

CEO / Agent
COMPETENCY CERTIFICATE

Herewith we certify that

____________________
ID No.: _____________________
Received sufficient training and experience on the job

with more than 2 years of experience (GSR 11.(2))

thus declaring him competent in the following trade:

1.) CONSTRUCTION MANAGER

2.) H&S COMMITTEE MEMBER

3.)

Awarded on this

03rd day of JULY in the year 2018

_________________________________

CEO /Agent
COMPETENCY CERTIFICATE

Herewith we certify that

____________________
ID No.: _____________________
Received sufficient training and experience on the job

with more than 2 years of experience (GSR 11.(2))

thus declaring him competent in the following trade:

1.) ASSISTANT CONSTRUCTION MANAGER

2.) CONSTRUCTION SUPERVISOR

3.)

Awarded on this

03rd day of JULY in the year 2018

_________________________________

CEO /Agent